Immunoprophylaxis and immunotherapy of Gram-negative infections in the immunocompromised host

Gram-negative infections remain a prominent cause of serious morbidity and mortality in hospitalized patients despite skilful antibiotic therapy and supportive care. A recently developed immunological approach to this problem is based on antiserum to an E. coli mutant (J5) which elicits antibody cross-reactive with a wide range of Gram-negative pathogens. The antitoxic and protective powers of E. coli J5 antiserum have been demonstrated in animal models. In carefully conducted clinical trials, J5 antiserum or J5 plasma of human origin has been established as a potent adjunctive therapy for the severe consequences of Gram-negative bacteraemia and in the prophylaxis of such infections in surgical patients. The question remains open whether such antiserum may have a similar prophylactic power in severely neutropenic patients. Clinical trials currently underway or soon to be started should help to clarify the practical prophylactic power of J5 hyperimmune globulin against shock and death in high-risk patients.