Acquired immunoparalysis in paediatric intensive care: prospective observational study

The increase in high technology medicine, complex surgical techniques, and use of immunosuppressive agents means that more patients are managed with broad spectrum antibiotics.Such regimens may contribute to the emergence of multidrug resistant micro-organisms, 1 and many authorities are now rationalising use of antibiotics in hospital to try to limit the spread of antibiotic resistant organisms.For this strategy to be successful, however, it should be combined with attempts to limit the requirement for antibiotic treatment in patients in hospital. 1 Recent studies indicate that many inpatients may be predisposed to infectious complications because of altered host defences.A subgroup of adults in intensive care with severe sepsis has been shown to express low amounts of HLA-DR on circulating monocytes; this was associated with a relatively immunodeficient state termed monocyte deactivation 2 or immunoparalysis.These patients improved after being given the cytokine interferon gamma.These observations suggest that focusing on host defences may provide an additional strategy for reducing antimicrobial resistance in hospitals.