Alpha-Toxin in Deep Tracheal Aspirates-Preliminary Evidence for Its Presence in the Lungs of Sepsis Patients.

The pore forming alpha-toxin (hemolysin A, Hla) of () is a major virulence factor with relevance for the pathogenicity of this bacterium, which is involved in many cases of pneumonia and sepsis in humans. Until now, the presence of Hla in the body fluids of potentially infected humans could only be shown indirectly, e.g.

Excessive tryptophan catabolism along the kynurenine pathway precedes ongoing sepsis in critically ill patients.

It has recently been shown that an increased plasma level of the tryptophan catabolite kynurenine is an early indicator for the development of sepsis in major trauma patients. We examined the predictive value of kynurenine pathway activity for ongoing sepsis in patients being admitted to a surgical intensive care unit for different reasons. In addition, we asked whether an accumulation of kynurenines in patients' plasma depends on reduced renal clearance.

[Study protocol of the VISEP study. Response of the SepNet study group].

In the commentary by Zander et al. the authors appear concerned about the methods and results of our, at that time, unpublished sepsis trial evaluating hydroxyethyl starch (HES) and insulin therapy. Unfortunately, the authors' concerns are based on false assumptions about the design, conduct and modes of action of the compounds under investigation.

Intensive insulin therapy and pentastarch resuscitation in severe sepsis.

Background: The role of intensive insulin therapy in patients with severe sepsis is uncertain. Fluid resuscitation improves survival among patients with septic shock, but evidence is lacking to support the choice of either crystalloids or colloids.

Methods: In a multicenter, two-by-two factorial trial, we randomly assigned patients with severe sepsis to receive either intensive insulin therapy to maintain euglycemia or conventional insulin therapy and either 10% pentastarch, a low-molecular-weight hydroxyethyl starch (HES 200/0.

Epidemiology of sepsis in Germany: results from a national prospective multicenter study.

Objective: To determine the prevalence and mortality of ICU patients with severe sepsis in Germany, with consideration of hospital size.

Design: Prospective, observational, cross-sectional 1-day point-prevalence study.

Setting: 454 ICUs from a representative nationwide sample of 310 hospitals stratified by size.