Survival after multiple traumas is associated with improved outcomes from gram-negative sepsis: Clinical and experimental evidence. Issue 2 (February 2017)

• Record Type: Journal Article
• Authors: Mandragos, Eleftherios; Pistiki, Aikaterini; Tsangaris, Iraklis; Routsi, Christina; Paraschos, Michael; Droggiti, Dionyssia-Irene; Savvidou, Olga; Mastrokalos, Dimitrios; Papagelopoulos, Panayiotis J.; Netea, Mihai G.; Giamarellos-Bourboulis, Evangelos J.
• Is Part Of: Journal of infection. Volume 74:Issue 2(2017)
• Page Start: 163
• Page End: 171
• Publication Date: 2017-02
• Subjects: Multiple trauma -- Sepsis -- Cytokines -- Interleukin-10 -- Survival; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2016.10.007
• Languages: English
• ISSNs: 0163-4453

Abstract

Summary: Objectives: We investigated the susceptibility to Gram-negative sepsis after multiple traumas (MT). Methods: From a prospective cohort of 5076 Greek patients with sepsis, 16 with Gram-negative bacteremia after MT were compared with 204 patients well-matched for severity, comorbidities and appropriateness of antimicrobials; circulating mononuclear cells were isolated and stimulated for the release of interleukin (IL)-10. Male C57Bl6J mice were subject to MT (right pneumothorax and right femur fracture) followed after 72 h by the intravenous challenge with Pseudomonas aeruginosa . Survival was recorded and splenocytes were isolated for cytokine stimulation. Results: 28-day mortality after MT was 18.8% compared to 48.0% of comparators (48.0%) (odds ratio 0.25, p: 0.035). This was confirmed after logistic regression analysis taking into consideration comorbidities and age. Stimulation of IL-10 was enhanced from MT patients. Survival of mice challenged by P. aeruginosa 72 h after MT was prolonged compared to mice challenged by P. aeruginosa without prior MT. Cytokine production was decreased 24 h after MT and restored 96 h thereafter. Production of IL-10 was particularly pronounced from splenocytes of mice challenged by P. aeruginosa after MT. Conclusions: Survival after MT is accompanied by favorable immune responses allowing survival benefit from Gram-negative sepsis. This is associated with increased IL-10 release. Highlights: Prior multiple trauma (MT) provides survival benefit from Gram-negative sepsis. This is associated with increased IL-10 production by circulating monocytes. Prior MT provides survival benefit from experimental P. aeruginosa infection. Increased IL-10 production and lower bacterial outgrowth are potential mechanisms.