Immunotherapeutic advances in the treatment of gram-negative bacterial sepsis.

Abstract

AbstractGram‐negative bacterial sepsis with the frequent sequelae of shock, multi‐system organ failure, and death represents one of the most severe infections that can occur in the surgical patient. Fatality in most series has paralleled the presence and severity of underlying host disease processes, polymicrobial bacteremia, shock, and lack of early appropriate antimicrobial therapy. Even patients with no underlying disease state have a significant mortality (10–20%). Therapy of gram‐negative bacterial sepsis and shock at present consists of antimicrobial agents, hemodynamic monitoring, aggressive fluid resuscitation, and metabolic support. The use of these treatment modalities in concert has reduced, but not eliminated, the severe consequences that may ensue. Administration of antibody directed against the comon core lipopolysaccharide antigen of gramnegative microorganisms to patients with gram‐negative sepsis represents a means by which the morbidity and mortality of this disease process may be further reduced. This is supported by a large body of experimental evidence, as well as several preliminary clinical studies. It is necessary to determine how the clinical efficacy of such antibody preparations can be maximized. This will entail rigorously controlled studies in which the timing of antibody administration and dose utilized can be correlated with clinical efficacy. Should such antibody preparations continue to prove efficacious as an additive form of therapy, it may be possible to identify high‐risk groups of patients who would benefit from antibody prophylaxis.