Sepsis and septic shock: Pathogenesis and treatment perspectives

• Published in: Journal of critical care Vol. 40; pp. 229 - 242
• Main Author: Minasyan, Hayk
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2017; Elsevier Limited
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotics; Bacteremia; Bacteremia - blood; Bacteremia - drug therapy; Bacteremia - microbiology; Bacteremia - physiopathology; Bacteria; Biofilms; Critical Care; E coli; Gram-Negative Bacteria - metabolism; Gram-Positive Bacteria - metabolism; Humans; Immune system; Mortality; Oxidation; Oxidative stress; Oxygen - metabolism; Pathogenesis; Pathogens; Patients; Plasma Exchange; Respiration; Rodents; Sepsis; Septic shock; Shock, Septic - blood; Shock, Septic - drug therapy; Shock, Septic - microbiology; Shock, Septic - physiopathology; Streptococcus infections; Treatment; Sepsis; Septic shock; Treatment; Pathogenesis; Bacteremia
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2017.04.015

Abstract The majority of bacteremias do not develop to sepsis: bacteria are cleared from the bloodstream. Oxygen released from erythrocytes and humoral immunity kill bacteria in the bloodstream. Sepsis develops if bacteria are resistant to oxidation and proliferate in erythrocytes. Bacteria provoke oxygen release from erythrocytes to arterial blood. Abundant release of oxygen to the plasma triggers a cascade of events that cause: 1. oxygen delivery failure to cells; 2. oxidation of plasma components that impairs humoral regulation and inactivates immune complexes; 3. disseminated intravascular coagulation and multiple organs' failure. Bacterial reservoir inside erythrocytes provides the long-term survival of bacteria and is the cause of ineffectiveness of antibiotics and host immune reactions. Treatment perspectives that include different aspects of sepsis development are discussed.