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. 2017 Nov;36(11):2171-2177.
doi: 10.1007/s10096-017-3041-5. Epub 2017 Jun 21.

Lipid peroxidation in Gram-negative bacteremia modulates the risk for septic shock and infections by resistant Klebsiella pneumoniae

S Christodoulou  1 , E Kyriazopoulou  2 , M Chrysanthakopoulou  3 , G Karlis  4 , I Karampela  5 , K Gkizeli  6 , N Veliki  7 , A Safarika  2 , E J Giamarellos-Bourboulis  8   9 , G Adamis  1 ; Hellenic Sepsis Study Group
Affiliations

Lipid peroxidation in Gram-negative bacteremia modulates the risk for septic shock and infections by resistant Klebsiella pneumoniae

S Christodoulou et al. Eur J Clin Microbiol Infect Dis. 2017 Nov.

Abstract

Controversies in outcomes with the parenteral administration of antioxidants as adjuvant therapies led to the measurement of malondialdehyde (MDA), a product of lipid peroxidation, in serum collected from 120 patients with primary Gram-negative bacteremia during the first 24 h from sepsis onset. MDA was measured by the thiobarbiturate assay, followed by high-performance liquid chromatography (HPLC) analysis. After receiver operator characteristic (ROC) curve analysis, patients were divided into those with high levels of MDA and low levels of MDA. The primary endpoint was the association of the level of MDA with septic shock. The level of MDA as an index of neutrophil function and associations with outcome and with infections by carbapenem-resistant Klebsiella pneumoniae were the secondary endpoints. In total, 63 patients had high and 57 had low MDA levels; 27% and 49.1%, respectively, had septic shock (p = 0.015). The rate of the concentration of MDA to the total neutrophil count was used as an expression of neutrophil function; this was lower among patients with septic shock. The odds ratio (OR) for death among patients without septic shock and low level of MDA was 4.00; this was 0.48 for patients with septic shock (p = 0.020 between the two ORs). The OR for resistance to carbapenems among patients with bacteremia by K. pneumoniae and low level of MDA was 7.50 (p = 0.011 compared to patients with bacteremia by other pathogens). Low level of circulating MDA is associated with susceptibility to septic shock and infections by carbapenem-resistant K. pneumoniae.

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Conflict of interest statement

None of the authors has any conflict related to this submission.

Figures

Fig. 1
Fig. 1
Study flow chart of the selection of sepsis patients for the measurement of malondialdehyde (MDA). SIRS systemic inflammatory response syndrome
Fig. 2
Fig. 2
The association of MDA and septic shock. a Frequency of septic shock in relation to circulating MDA. b Comparison of neutrophil index between patients with septic shock and patients without septic shock. c Frequency of septic shock in relation to the neutrophil index. The ratio of MDA to the absolute neutrophil count was considered an index of neutrophil function. p-Values indicate respective statistical comparisons. CI confidence interval
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