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J Infect. 2017 Feb;74(2):163-171. doi: 10.1016/j.jinf.2016.10.007. Epub 2016 Nov 5.

Survival after multiple traumas is associated with improved outcomes from gram-negative sepsis: Clinical and experimental evidence.

Author information

1
4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece.
2
2nd Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Greece.
3
1st Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Greece.
4
Intensive Care Unit, "Korgialeneion-Benakeion" General Hospital, Athens, Greece.
5
1st Department of Orthopaedics, National and Kapodistrian University of Athens, Medical School, Greece.
6
Department of Internal Medicine, Radboud University Nijmegen, The Netherlands.
7
4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece. Electronic address: egiamarel@med.uoa.gr.

Abstract

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.

KEYWORDS:

Cytokines; Interleukin-10; Multiple trauma; Sepsis; Survival

PMID:
27826063
DOI:
10.1016/j.jinf.2016.10.007
[Indexed for MEDLINE]

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