DIFFERENT ENDOTOXIN RELEASE AND IL-6 PLASMA-LEVELS AFTER ANTIBIOTIC ADMINISTRATION IN SURGICAL INTENSIVE-CARE PATIENTS

Despite the use of broad-spectrum antibiotics, aggressive fluid resusc itation, vasopressor support, the mortality associated with Gram-negat ive sepsis and septic shock has not decreased significantly in the las t two decades. The consequences of host exposure to endotoxin and the relationship of antibiotic administration to endotoxin release have be come important areas of intense interest. In vitro studies have demons trated that there was a difference in endotoxin release between PBP-3 specific antibiotics (beta-lactam antibiotics) and PBP-2 specific anti biotics (carbapenems). This is the first clinical report of surgical p atients admitted to the surgical and anaesthesiology intensive care un it on the missing endotoxin release after imipenem treatment; however cefotaxime and ceftriaxone showed significantly more positive endotoxi n tests in the plasma when compared to imipenem. Ciprofloxacin and van comycin were intermediate in endotoxin release and tobramycin did not cause endotoxin release. There were also significant differences in en dotoxin neutralizing capacity. IL-6 levels were decreased after imipen em faster than after ceftriaxone or cefotaxime; ciprofloxacin seemed t o increase IL-6. Endotoxin may be harmful in patients where the immune system has been continuously challenged. Timing, dosage, or combinati on with other compounds as well as the effect of antibiotics on macrop hages need to be tested in larger clinical trials. In this respect a c onsecutive study was started.