Aretha Diamanto, Leukaditou Katerina, Fligou Fotini, Akinosoglou Karolina, Spyridonidis Alexandros, Nikolopoulou Alexandra, Assimakopoulos Stelios F
Intensive Care Medicine, University General Hospital of Patras, 26504 Patras, Greece.
Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Patras, Greece.
J Clin Med Res. 2021 Jan;13(1):64-72. doi: 10.14740/jocmr4409. Epub 2021 Jan 12.
Immunoglobulins (Igs) and cells of the innate and adaptive immune systems play a critical role in a host's response to sepsis. The aim of this study was to investigate the possible differences in the levels of Igs, white blood cells (WBCs), and T and B lymphocytes cells in relation to the microbiological and clinical responses of patients with sepsis or septic shock from carbapenem non-susceptible Gram-negative bacteria (CnS-GNB).
This pilot cohort study involved 24 hospitalized patients with sepsis or septic shock due to bacteremia from CnS-GNB. The microbiological and clinical responses of the patients were evaluated in relation to their blood levels of IgA, IgE, IgM and IgG, as well as WBCs and subpopulations of T and B cells upon sepsis diagnosis. A microbiological response was determined as clearance of bacteremia at 14 days of active antibiotic treatment for the isolated bacterial pathogen. Clinical response was defined as the resolution of all clinical and laboratory signs of infection and sepsis at 14 days of active antibiotic treatment for the isolated pathogen.
From the 24 patients included in the study 18 (75%) and six patients (25%) presented and did not present microbiological response respectively, while 16 patients presented clinical response (64%) and eight patients (36%) did not have clinical response. The levels of the Igs did not show statistically significant differences between patients with sepsis from CnS-GNB bacteremia who exhibited microbiological or clinical response. There were also no statistically significant differences in the levels of WBCs and the subpopulations of T and B cells levels for these patients (P > 0.05). According to this pilot study, peripheral blood Igs and lymphocyte subpopulations levels do not affect the clinical and microbiological response of septic patients with bacteremia from CnS-GNB.
In patients with sepsis or septic shock from CnSGNB, there were no differences in the levels of Igs, circulating WBCs and T and B cells subpopulations between those with microbiological or clinical response and non-responders.
免疫球蛋白（Igs）以及先天性和适应性免疫系统的细胞在宿主对脓毒症的反应中起着关键作用。本研究的目的是调查感染碳青霉烯不敏感革兰氏阴性菌（CnS - GNB）的脓毒症或脓毒性休克患者，其免疫球蛋白、白细胞（WBCs）以及T和B淋巴细胞水平在微生物学和临床反应方面可能存在的差异。
这项前瞻性队列研究纳入了24例因CnS - GNB菌血症而住院的脓毒症或脓毒性休克患者。在脓毒症诊断时，根据患者血液中IgA、IgE、IgM和IgG水平，以及白细胞和T、B细胞亚群情况，评估患者的微生物学和临床反应。微生物学反应定义为针对分离出的细菌病原体进行14天积极抗生素治疗后菌血症清除。临床反应定义为针对分离出的病原体进行14天积极抗生素治疗后，所有感染和脓毒症的临床及实验室体征消退。
研究纳入的24例患者中，分别有18例（75%）和6例（25%）呈现和未呈现微生物学反应，而16例患者呈现临床反应（64%），8例患者（36%）未出现临床反应。来自CnS - GNB菌血症的脓毒症患者中，呈现微生物学或临床反应者之间免疫球蛋白水平未显示出统计学显著差异。这些患者的白细胞水平以及T和B细胞亚群水平也无统计学显著差异（P>0.05）。根据这项前瞻性研究，外周血免疫球蛋白和淋巴细胞亚群水平不影响CnS - GNB菌血症脓毒症患者的临床和微生物学反应。
在感染CnS - GNB的脓毒症或脓毒性休克患者中，有微生物学或临床反应者与无反应者之间，免疫球蛋白、循环白细胞以及T和B细胞亚群水平无差异。
