Abstract
Background Gram-positive and Gram-negative bacteria are the most common causative pathogens in community-acquired pneumonia (CAP) on the intensive care unit (ICU). The aim of this study was to determine whether the host immune response differs between Gram-positive and Gram-negative CAP upon ICU admission.
Methods 16 host response biomarkers providing insight into pathophysiological mechanisms implicated in sepsis and blood leukocyte transcriptomes were analysed in patients with CAP upon ICU admission in two tertiary hospitals in the Netherlands.
Results 309 patients with CAP with a definite or probable likelihood (determined by predefined criteria) were included. A causative pathogen was determined in 74.4% of admissions. Patients admitted with Gram-positive CAP (n=90) were not different from those admitted with Gram-negative CAP (n=75) regarding demographics, chronic comorbidities, severity of disease and mortality. Host response biomarkers reflective of systemic inflammation, coagulation activation and endothelial cell function, as well as blood leukocyte transcriptomes, were largely similar between Gram-positive and Gram-negative CAP. Blood leukocyte transcriptomes were also similar in Gram-positive and Gram-negative CAP in two independent validation cohorts. On a pathogen-specific level, Streptococcus pneumoniae and Escherichia coli induced the most distinct host immune response.
Conclusion Outcome and host response are similar in critically ill patients with CAP due to Gram-positive bacteria compared with Gram-negative bacteria.
Abstract
Outcome and host response in critically ill patients with community-acquired pneumonia are similar when caused by Gram-positive compared with Gram-negative bacteria https://bit.ly/3rMll2r
Footnotes
Conflict of interest: L. Pereverzeva has nothing to disclose.
Conflict of interest: F. Uhel has nothing to disclose.
Conflict of interest: H. Peters Sengers reports grants from the Dutch Kidney Foundation (Nierstichting) (grant 19OK009), outside the submitted work.
Conflict of interest: J. Butler has nothing to disclose.
Conflict of interest: L.A. van Vught has nothing to disclose.
Conflict of interest: K.L. Burnham has nothing to disclose.
Conflict of interest: E.E. Davenport has nothing to disclose.
Conflict of interest: J.C. Knight has nothing to disclose.
Conflict of interest: O.L. Cremer has nothing to disclose.
Conflict of interest: M.J. Schultz has nothing to disclose.
Conflict of interest: M.M.J. Bonten has nothing to disclose.
Conflict of interest: B.P. Scicluna has nothing to disclose.
Conflict of interest: T. van der Poll has nothing to disclose.
Support statement: This work was supported by the Center for Translational Molecular Medicine (04I-201). Funding information for this article has been deposited with the Crossref Funder Registry.
- Received October 27, 2020.
- Accepted July 21, 2021.
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