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Dynamics of monocytic HLA-DR expression differs between bacterial etiologies during the course of bloodstream infection
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.
Department of Infectious Diseases, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
Örebro University, School of Medical Sciences. Department of Clinical Research Laboratory, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
(Clinical Epidemiology and Biostatistics)
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 2, article id e0192883Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: In the pathogenesis of sepsis, activation of both pro- and anti-inflammatory responses are key components, but knowledge is lacking on the association between bacterial etiology and development of dysregulated responses with sustained immunosuppression. The aim of this study was to evaluate how the immunosupression marker HLA-DR on monocytes (mHLA-DR) is associated with bacterial etiology and markers of inflammation during the clinical trajectory of bloodstream infection (BSI).

METHODS: Ninety-one adults, predominantly non-ICU patients, with BSI caused by Streptococcus pneumoniae (n = 27), Staphylococcus aureus (n = 22), Escherichia coli/Klebsiella pneumoniae (n = 23), and other species (n = 19) were prospectively included, and sampled on admission (day 0) and on days 1-2, 3, 7±1, 14±2, and 28±4.

RESULTS: The dynamics of mHLA-DR, measured by flow cytometry, differed significantly between etiology groups (p<0.001). Patients with S. pneumoniae and S. aureus BSI demonstrated low initial mHLA-DR, with the S. aureus group showing delayed recovery over time. Eleven patients (55% S. aureus) had negative outcome (secondary bacteremia or death) and they demonstrated sustained C-reactive protein elevation, neutrophilia, lymphocytopenia, and loss of mHLA-DR.

CONCLUSIONS: Dynamics of mHLA-DR varied according to the bacterial etiology of infection, with delayed recovery in patients with S. aureus BSI. Patients with negative outcome showed sustained CRP elevation, neutrophilia, lymphocytopenia, and low levels of mHLA-DR, supporting the theory of a dysregulated host response with persistent inflammation and immunosuppression in late stages of deleterious sepsis.

Place, publisher, year, edition, pages
Public Library of Science , 2018. Vol. 13, no 2, article id e0192883
National Category
Infectious Medicine
Identifiers
URN: urn:nbn:se:oru:diva-65287DOI: 10.1371/journal.pone.0192883ISI: 000425604300071PubMedID: 29466395Scopus ID: 2-s2.0-85042254936OAI: oai:DiVA.org:oru-65287DiVA, id: diva2:1186113
Note

Funding Agencies:

Research Committee of Örebro County Council  

ALF research funding (Örebro University)  

Nyckelfonden (Örebro University Hospital)  

ALF research funding (Örebro) 

Available from: 2018-02-27 Created: 2018-02-27 Last updated: 2018-09-13Bibliographically approved

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Cajander, SaraTina, ElisabetSöderquist, BoKällman, Jan

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