Delay in antibiotic therapy results in fatal disease outcome in murine pneumococcal pneumonia

Berger S, Goekeri C, Gupta SK, Vera J, Dietert K, Behrendt U, Lienau J, Wienhold SM, Gruber AD, Suttorp N, Witzenrath M, Nouailles G (2018)

Publication Type: Journal article

Publication year: 2018

Journal

Critical Care BioMed Central

Book Volume: 22

Journal Issue: 1

DOI: 10.1186/s13054-018-2224-5

Abstract

BACKGROUND: Community-acquired pneumonia (CAP) remains a major cause of death worldwide. Mechanisms underlying the detrimental outcome despite adequate antibiotic therapy and comorbidity management are still not fully understood. METHODS: To model timely versus delayed antibiotic therapy in patients, mice with pneumococcal pneumonia received ampicillin twice a day starting early (24 h) or late (48 h) after infection. Clinical readouts and local and systemic inflammatory mediators after early and late antibiotic intervention were examined. RESULTS: Early antibiotic intervention rescued mice, limited clinical symptoms and restored fitness, whereas delayed therapy resulted in high mortality rates. Recruitment of innate immune cells remained unaffected by antibiotic therapy. However, both early and late antibiotic intervention dampened local levels of inflammatory mediators in the alveolar spaces. Early treatment protected from barrier breakdown, and reduced levels of vascular endothelial growth factor (VEGF) and perivascular and alveolar edema formation. In contrast, at 48 h post infection, increased pulmonary leakage was apparent and not reversed by late antibiotic treatment. Concurrently, levels of VEGF remained high and no beneficial effect on edema formation was evident despite therapy. Moreover, early but not late treatment protected mice from a vast systemic inflammatory response. CONCLUSIONS: Our data show that only early antibiotic therapy, administered prior to breakdown of the alveolar-capillary barrier and systemic inflammation, led to restored fitness and rescued mice from fatal streptococcal pneumonia. The findings highlight the importance of identifying CAP patients prior to lung barrier failure and systemic inflammation and of handling CAP as a medical emergency.

Authors with CRIS profile

Julio Vera González Professur für Tumorimmunologie (Schwerpunkt Systembiologie)

Involved external institutions

Humboldt-Universität zu Berlin DE Germany (DE) Freie Universität Berlin DE Germany (DE) Charité - Universitätsmedizin Berlin DE Germany (DE)

How to cite

APA:

Berger, S., Goekeri, C., Gupta, S.K., Vera, J., Dietert, K., Behrendt, U.,... Nouailles, G. (2018). Delay in antibiotic therapy results in fatal disease outcome in murine pneumococcal pneumonia. Critical Care, 22(1). https://dx.doi.org/10.1186/s13054-018-2224-5

MLA:

Berger, Sarah, et al. "Delay in antibiotic therapy results in fatal disease outcome in murine pneumococcal pneumonia." Critical Care 22.1 (2018).

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