Survival after multiple traumas is associated with improved outcomes from gram-negative sepsis: Clinical and experimental evidence

J Infect. 2017 Feb;74(2):163-171. doi: 10.1016/j.jinf.2016.10.007. Epub 2016 Nov 5.


Objectives: We investigated the susceptibility to Gram-negative sepsis after multiple traumas (MT).

Methods: From a prospective cohort of 5076 Greek patients with sepsis, 16 with Gram-negative bacteremia after MT were compared with 204 patients well-matched for severity, comorbidities and appropriateness of antimicrobials; circulating mononuclear cells were isolated and stimulated for the release of interleukin (IL)-10. Male C57Bl6J mice were subject to MT (right pneumothorax and right femur fracture) followed after 72 h by the intravenous challenge with Pseudomonas aeruginosa. Survival was recorded and splenocytes were isolated for cytokine stimulation.

Results: 28-day mortality after MT was 18.8% compared to 48.0% of comparators (48.0%) (odds ratio 0.25, p: 0.035). This was confirmed after logistic regression analysis taking into consideration comorbidities and age. Stimulation of IL-10 was enhanced from MT patients. Survival of mice challenged by P. aeruginosa 72 h after MT was prolonged compared to mice challenged by P. aeruginosa without prior MT. Cytokine production was decreased 24 h after MT and restored 96 h thereafter. Production of IL-10 was particularly pronounced from splenocytes of mice challenged by P. aeruginosa after MT.

Conclusions: Survival after MT is accompanied by favorable immune responses allowing survival benefit from Gram-negative sepsis. This is associated with increased IL-10 release.

Keywords: Cytokines; Interleukin-10; Multiple trauma; Sepsis; Survival.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Animals
  • Cohort Studies
  • Comorbidity
  • Cytokines / biosynthesis
  • Cytokines / immunology
  • Disease Susceptibility*
  • Female
  • Gram-Negative Bacteria / isolation & purification
  • Gram-Negative Bacterial Infections / drug therapy
  • Gram-Negative Bacterial Infections / immunology*
  • Gram-Negative Bacterial Infections / microbiology
  • Humans
  • Interleukin-10 / immunology
  • Interleukin-10 / metabolism
  • Leukocytes, Mononuclear / drug effects
  • Male
  • Mice
  • Mice, Inbred C57BL
  • Middle Aged
  • Multiple Trauma / immunology*
  • Multiple Trauma / microbiology
  • Prospective Studies
  • Pseudomonas Infections / immunology
  • Pseudomonas Infections / microbiology
  • Pseudomonas aeruginosa / immunology
  • Pseudomonas aeruginosa / isolation & purification
  • Regression Analysis
  • Sepsis / drug therapy
  • Sepsis / immunology*
  • Sepsis / microbiology
  • Spleen / cytology
  • Survival Analysis


  • Cytokines
  • IL10 protein, human
  • Interleukin-10