Staphylococcus epidermidis - virulence factors and innate ... - Munin

inflammatory response syndrome (SIRS) (220). SIRS is a clinical entity with the following major
symptoms in adults; High or low body temperature (38 °C), heart rate > 90/min.,
respiratory rate >20/min (or PaCO2 < 4.3 kPa), and a high or low leukocyte count (12x10 9 /L, or 10% bands) (220). Sepsis is a diagnosis used in patients with SIRS plus growth of
bacteria from blood culture (221). The pro-inflammatory cytokines secreted during sepsis
probably also induce secretion of anti-inflammatory cytokines attempting to limit inflammation
(222-224). This anti-inflammatory cytokine secretion combined with expression of cytokine
antagonists (such as TNF receptors, IL-1Ra) (223, 225, 226) are referred to as the compensatory
anti-inflammatory response syndrome (CARS) (223, 227). A misbalance between the pro- and
anti-inflammatory cytokine responses may either lead to an inflammatory catastrophe for the
patient (too strong pro-inflammatory response) or failure to clear the infection (too strong antiinflammatory
response).
Specific aspects in neonates
Data in the literature are conflicting regarding the nature of the neonatal cytokine response to
common pathogens and inflammatory conditions. Some authors describe the pro-inflammatory
cytokine response in term infants (228-232) and preterm infants (232-234) as either equal or
lower than that found in adults. A lower pro-inflammatory cytokine response is considered
important to avoid alloimmune reactions between mother and fetus (235) and to make the
transition from the sterile intrauterine life into the symbiosis with colonizing bacteria as smooth
as possible (236, 237). However, a lower pro-inflammatory cytokine response may also render
the neonate more susceptible to infections (201).
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