The contribution of intestinal endotoxin to mortality in hosts with compromised resistance: a review

Sepsis, particularly with endotoxin-containing Gram-negative bacilli, is a serious complication in hosts whose defenses are compromised. This review examines work from our laboratory and others concerning infectious processes which may be critical to the survival of compromised individuals. Several avenues for control of sepsis are proposed. Gram-negative bacteria and their endotoxins can escape from the intestines of compromised animals to contaminate normally sterile host tissues. Endotoxins are especially toxic to compromised hosts because essential components of their inflammatory responses are missing (i.e., leukocytes and platelets in irradiated animals). Therefore, regulation of host responses to endotoxin is no longer possible. It is recommended that sepsis be controlled in compromised individuals through elimination of endogenous microbial agents. Should infection occur in these individuals, they should be transfused with blood cells necessary for clearance of bacteria and endotoxin and restoration of homeostasis.