Intensive Care Medicine

, Volume 28, Issue 7, pp 824–833 | Cite as

Clinical implications of antibiotic-induced endotoxin release in septic shock

  • P. Lepper
  • T. Held
  • E. Schneider
  • E. Bölke
  • H. Gerlach
  • M. Trautmann
Review

Abstract.

Antibiotic-induced release of bacterial cell wall components can have immediate adverse effects for the patient. This article reviews the data on endotoxin release after initiation of antibiotic therapy and its role in the pathogenesis of sepsis and septic shock. Antibiotics differ in their potential to liberate endotoxins from bacterial cell walls. When used for treatment of systemic Gram-negative infection, some classes of β-lactam antibiotics lead to markedly increased levels of free endotoxins while treatment with carbapenems and aminoglycosides produces relatively low amounts of endotoxins. Antibiotics that induce the formation of long, aberrant bacterial cells before effectively killing the microorganisms show the highest degree of endotoxin liberation. There is increasing evidence from animal models and clinical studies of sepsis that the antibiotic-mediated release of biologically active cell wall components derived from Gram-positive, Gram-negative or fungal organisms is associated with a rapid clinical deterioration.

TNFα TLR4 Sepsis Endotoxin Antibiotic therapy Induced endotoxaemia Septic shock syndrome 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • P. Lepper
    • 1
  • T. Held
    • 2
  • E. Schneider
    • 3
  • E. Bölke
    • 4
  • H. Gerlach
    • 5
  • M. Trautmann
    • 1
  1. 1.Dept. of Medical Microbiology and Hygiene, University Hospital, Steinhövelstr. 9, 89075 Ulm, GermanyGermany
  2. 2.Dept. of Haematology and Oncology, Charité/Campus Virchow-Klinikum, Humboldt-University, Berlin, GermanyGermany
  3. 3.Dept. of Anaesthesiology, Division of Experimental Anaesthesiology, University Hospital, Ulm, GermanyGermany
  4. 4.Dept. of Thoracic and Vascular Surgery, University Hospital, Ulm, GermanyGermany
  5. 5.Dept. of Anaesthesiology and Surgical Intensive Care Medicine, Charité/Campus Virchow-Klinikum, Humboldt-University, Berlin, GermanyGermany

Personalised recommendations