SYSTEMIC EXPRESION OF CYTOKINE PRODUCTION IN SEVERE PNEUMOCOCCAL PNEUMONIA. THE EFFECTS OF TREATMENT WITH A BET-LACTAM VS. A FLUOROQUINOLONE

Service of Internal Medicine, Infectious Diseases Unit, Hospital Mútua de Terrassa, Barcelona; Immunology Department, Hospital Mútua de Terrassa, Barcelona; Service of Microbiology, Hospital Mútua de Terrassa, Barcelona, Spain

^* To whom correspondence should be addressed. Email: esthercalbo{at}hotmail.com.

	Abstract

Bacterial alveolar invasion is followed by an inflammatory response. A systemic extension of the compartmentalized immune response has been described in patients with severe pneumonia. Data suggest that some antimicrobials may induce a differential release of cytokines. We conducted a prospective, randomized study in adult patients with severe pneumococcal pneumonia to measure the effects of ceftriaxone and levofloxacin in the systemic cytokine expression over time. Demographic, clinical characteristics and severity scores were recorded. The serum concentrations of Tumor Necrosis Factor (TNF), Interleukin 1 (IL1), IL6, IL8, IL10, IL 1ra were measured at 0, 24, 72 and 120 hours. 32 patients were included. Both groups were homogenous in terms of age, co morbidities, severity of disease, corticosteroid or statin use. With the single exception of IL 1, all cytokines were detected in venous blood. All cytokines studied showed a similar pattern of progressive decrease over time. No significant differences in the concentrations of any of the cytokines studied were found with the single exception of TNF which got lower concentrations at 120h in the levofloxacin group (p=0.014). Basal oxygen saturation (p=0.034) and heart rate (p=0.029) came back to normal values earlier in the levofloxacin arm. We demonstrated that in patients with severe pneumococcal pneumonia the pro and anti-inflammatory response could be detected in venous blood, representing a systemic extension of the compartmentalized response. Treatment with a -lactam agent or a fluoroquinolone has different effects on cytokine production and its systemic expression, impacting in the clinical course of the disease.