Please use this identifier to cite or link to this item: http://hdl.handle.net/11054/30
Title: The diagnosis of endotoxemia with gram negative bacteremia is bacterial species dependent: a meta-analysis of clinical studies.
Authors: Hurley, James C.
Issue Date: 2009
Publisher: American Society for Microbiology
Place of publication: Washington
Publication Title: Journal of Clinical Microbiology
Volume: 47
Issue: 12
Start Page: 3826
End Page: 3831
Abstract: Endotoxemia is undetectable for up to 60% of cases of bacteremia caused by gram-negative (GN) species, a discordance attributed to the limitations of the Limulus assay for endotoxemia. The lipid A structure of the endotoxin molecule is critical for the sensing of GN bacteria by the host immune system although not so for sensing by the Limulus assay. The lipid A structure of commensal Enterobacteriaceae is hexa-acyl, whereas non-Enterobacteriaceae have a broader range of structures. By using a previously published classification of lipid A structures (R. S. Munford, Infect. Immun. 76:454-465, 2008), the association of endotoxemia with bacteremia caused by GN organisms is reexamined for 580 GN bacteremic patients from 46 studies. Endotoxemia was less commonly detected for cases of bacteremia caused by Salmonella enterica serovar Typhi (four studies; 15 of 55 cases of bacteremia [27%]) than for cases of bacteremia caused by Neisseria meningitidis (five studies; 69 of 84 cases [82%]) and Pseudomonas pseudomallei (one study; 38 of 41 cases [93%]) among studies restricted to those with specified cases of bacteremia caused by GN organisms. Among 23 unrestricted studies, endotoxemia was less commonly detected for cases of bacteremia with a commensal member of the Enterobacteriaceae (104 of 240 cases [43%]) than with non-Enterobacteriaceae (59 of 100 cases [59%]) (summary odds ratio, 0.53 [90% confidence interval, 0.33 to 0.85]). This finding is consistent across all the unrestricted studies, even including studies with seemingly contrary results for endotoxemia diagnosis among cases of bacteremia caused by GN bacteria overall. Surprisingly, with bacteremia caused by commensal Enterobacteriaceae, the diagnosis of endotoxemia appears to be unrelated to the Limulus assay sensitivity. Across these 45 studies, the association of endotoxemia with GN bacteremia is variable but consistent for different types of GN bacteremia.
URI: http://hdl.handle.net/11054/30
Resource Link: http://jcm.asm.org/content/47/12/3826.short
ISSN: 0095-1137
Internal ID Number: 00017
Health Subject: META ANALYSIS
ANIMALS
BACTEREMIA - COMPLICATIONS
BACTEREMIA - MICROBIOLOGY
ENDOTOXEMIA - COMPLICATIONS
ENDOTOXEMIA - DIAGNOSIS
ENDOTOXEMIA - MICROBIOLOGY
ENTEROBACTERIACEAE - CLASSIFICATION
ENTEROBACTERIACEAE - ISOLATION AND PURIFICATION
GRAM NEGATIVE BACTERIA - CLASSIFICATION
GRAM NEGATIVE BACTERIA - ISOLATION AND PURIFICATION
HORSESHOE CRABS
HUMANS
NEISSERIA MENINGITIDIS - ISOLATION AND PURIFICATION
PSEUDOMONAS - ISOLATION AND PURIFICATION
SALMONELLA TYPHI - ISOLATION AND PURIFICATION
SPECIES SPECIFICITY
Type: Journal Article
Article
Appears in Collections:Research Output

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