Interactions of phagocytic and bacterial cells in patients with bacteremia caused by gram-negative rods

The phagocytic and bactericidal functions of polymorphonuclear leukocytes and monocytes and the opsonic activity of serum from patients with gram-negative bacteremia were compared with those of cells and serum from healthy donors and control patients. Leukocytes from five of 20 patients showed diminished phagocytic capacity. Leukocytes from three of 12 patients had decreased chemotactic activity. Eleven of 37 blood culture isolates were inefficiently phagocytized after opsonization in homologous patient serum. However, in no instance was the opsonic capacity of patient serum significantly lower than that of control serum. In the serum of some patients, an increase in heat-stable opsonins was found during the course of infection. Resistance to opsonization of strains of Escherichia coli correlated with the presence of K capsular polysaccharide. It was concluded that both impaired leukocyte function and ineffective opsonization play a role in the pathogenesis of gram-negative bacteremia. Heat-stable opsonins (presumably specific antibodies) appear to be necessary for effective phagocytosis of bacilli that cause gram-negative bacteremia.