tailieunhanh - Báo cáo y học: " Gram-negative versus Gram-positive bacteremia: what is more alarmin"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Gram-negative versus Gram-positive bacteremia: what is more alarmin(g)? | Alexandraki and Palacio Critical Care 2010 14 161 http content 14 3 161 CRITICAL CARE COMMENTARY L__ Gram-negative versus Gram-positive bacteremia what is more alarmin g Irene Alexandraki and Carlos Palacio See related research by Abe etal. http content 14 2 R27 Abstract Gram-negative bacteremia has been associated with severe sepsis although the exact mechanism and pathophysiological differences among bacterial species are not well understood. In the previous issue of Critical Care Abe and colleagues report results of a retrospective study that show a significantly higher incidence of Gram-negative bacteremia among adult intensive care unit patients with septic shock than in those with sepsis or severe sepsis. In this study C-reactive protein and IL-6 levels were significantly higher in Gram-negative bacteremia than in Grampositive bacteremia. These observations suggest a distinct immunopathophysiologic behavior of sepsis in patients with Gram-negative bacteremia that may influence clinical outcomes. Future research exploring new biomarkers and danger signals and further characterizing differences in the virulence mechanisms between Gram-negative and Gram-positive bacteria appears promising and could lead to new therapeutics and to improved clinical outcomes. Gram-negative GN bacteria have often been implicated in the pathogenesis of severe sepsis and septic shock although the exact mechanism is uncertain 1 . There is evidence to support two different theories on how GN bacteria induce harmful systemic responses. The intravascular stimulus hypothesis posits that bacteria invade through a normal or damaged epithelium and enter the bloodstream inducing systemic inflammatory responses for example increased vascular permeability leukocyte-endothelial adhesion and activation of complement and clotting pathways and resulting in multiorgan failure. A second theory suggests that the multiorgan dysfunction and shock result from .