Immune System Dysfunction and Multidrug-resistant Bacteria in Critically Ill Patients: Inflammasones and Future Perspectives

Despite the significant improvements in knowledge, technology and pharmacology obtained in the last few decades, we are not yet ready to provide individualized therapy for critically ill patients with sepsis. Clinicians tend to manage patients according to evidence-based guidelines that are derived from large randomized trials in which single patient characteristics and types of infection are rarely considered. But, as is well known, different types of infection in patients with different characteristics may cause different consequences and may need different treatments. One of the aspects that remains rather unexplored in clinical practice is the immune response of the patient in the intensive care unit (ICU). On a day-to-day basis in the ICU we are dealing with patients who have a higher susceptibility to nosocomial infections with multidrug-resistant (MDR) bacteria without really understanding the cause. Antibiotic therapy alone in these patients is frequently insufficient, so it is necessary to study an alternative way to make sure that the immune response can actively participate in the elimination of the pathogens [1]. Infection with MDR bacteria frequently occurs in debilitated patients, such as those with shock, surgical complications, prolonged antibiotic therapies and immunosuppressive therapy [2]. The association between MDR infection and immunoparalysis is likely due to a disorder of innate and adaptive immune responses in critically ill patients.