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Int J Infect Dis. 2008 Nov;12(6):660-70. doi: 10.1016/j.ijid.2008.03.009. Epub 2008 Jun 2.

The role of the innate immune response in hospital- versus community-acquired infection in febrile medical patients.

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1
Department of Intensive Care, Institute for Cardiovascular Research, Vrije Universiteit Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands. johan.groeneveld@vumc.nl

Abstract

OBJECTIVES:

To study the role of the innate immune response in the higher mortality of hospital- than of community-acquired infections, in febrile medical patients.

METHODS:

We studied presumably immunocompetent patients with new-onset fever and a clinically presumed focus of infection (N=212) at a university department of internal medicine. Clinical and microbiological data were collected for 2 days from inclusion, and circulating complement activation product C3a, secretory phospholipase A(2), interleukin (IL)-6, procalcitonin, and elastase-alpha(1)-antitrypsin were measured. Patients were followed for septic shock and outcome, up to a maximum of 7 and 28 days after inclusion, respectively. Infection was considered hospital-acquired if it developed at least 72h after admission.

RESULTS:

Fifty-four patients had hospital-acquired infections and 158 had community-acquired infections, with septic shock and mortality rates of 15% and 24%, and 4% and 6% (p=0.001), respectively. Bloodstream infection predisposed to septic shock and the latter predisposed to death. Bloodstream infection was relatively more common in septic shock originating from community-acquired infection and was associated with an innate immune response in both hospital- and community-acquired infection, as judged from circulating immune variables. In contrast, circulating C3a, IL-6, and procalcitonin were more elevated when septic shock developed following hospital- than community-acquired infection, independent of infectious focus. The levels of C3a, secretory phospholipase A(2), IL-6, and elastase-alpha(1)-antitrypsin were more elevated in ultimate non-survivors than in survivors in both infection groups.

CONCLUSIONS:

The data suggest that rates of septic shock and mortality from hospital- vs. community-acquired infections in febrile medical patients are not increased by impaired innate immunity. In contrast, proinflammatory factors may be particularly useful to predict a downhill course in hospital-acquired infections.

PMID:
18514561
DOI:
10.1016/j.ijid.2008.03.009
[Indexed for MEDLINE]
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