Please use this identifier to cite or link to this item: http://hdl.handle.net/11054/30
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dc.contributor.authorHurley, James C.en
dc.date.accessioned2012-10-10T05:33:51Zen
dc.date.available2012-10-10T05:33:51Zen
dc.date.issued2009en
dc.identifier.govdoc00017en
dc.identifier.issn0095-1137en
dc.identifier.urihttp://hdl.handle.net/11054/30en
dc.description.abstractEndotoxemia 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.en
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dc.publisherAmerican Society for Microbiologyen
dc.relation.urihttp://jcm.asm.org/content/47/12/3826.shorten
dc.titleThe diagnosis of endotoxemia with gram negative bacteremia is bacterial species dependent: a meta-analysis of clinical studies.en
dc.typeJournal Articleen
dc.type.specifiedArticleen
dc.bibliographicCitation.titleJournal of Clinical Microbiologyen
dc.bibliographicCitation.volume47en
dc.bibliographicCitation.issue12en
dc.bibliographicCitation.stpage3826en
dc.bibliographicCitation.endpage3831en
dc.publisher.placeWashingtonen
dc.subject.healththesaurusMETA ANALYSISen
dc.subject.healththesaurusANIMALSen
dc.subject.healththesaurusBACTEREMIA - COMPLICATIONSen
dc.subject.healththesaurusBACTEREMIA - MICROBIOLOGYen
dc.subject.healththesaurusENDOTOXEMIA - COMPLICATIONSen
dc.subject.healththesaurusENDOTOXEMIA - DIAGNOSISen
dc.subject.healththesaurusENDOTOXEMIA - MICROBIOLOGYen
dc.subject.healththesaurusENTEROBACTERIACEAE - CLASSIFICATIONen
dc.subject.healththesaurusENTEROBACTERIACEAE - ISOLATION AND PURIFICATIONen
dc.subject.healththesaurusGRAM NEGATIVE BACTERIA - CLASSIFICATIONen
dc.subject.healththesaurusGRAM NEGATIVE BACTERIA - ISOLATION AND PURIFICATIONen
dc.subject.healththesaurusHORSESHOE CRABSen
dc.subject.healththesaurusHUMANSen
dc.subject.healththesaurusNEISSERIA MENINGITIDIS - ISOLATION AND PURIFICATIONen
dc.subject.healththesaurusPSEUDOMONAS - ISOLATION AND PURIFICATIONen
dc.subject.healththesaurusSALMONELLA TYPHI - ISOLATION AND PURIFICATIONen
dc.subject.healththesaurusSPECIES SPECIFICITYen
dc.date.issuedbrowse2009-01-01en
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