World Journal of Emergency Medicine ›› 2025, Vol. 16 ›› Issue (1): 10-17.doi: 10.5847/wjem.j.1920-8642.2025.001
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Azzah S Alharbi1,2(
), Raghad Hassan Sanyi3, Esam I Azhar2,4
Received:2024-05-29
Accepted:2024-10-20
Online:2025-01-23
Published:2025-01-01
Contact:
Azzah S Alharbi, Email: asalharbi3@kau.edu.saAzzah S Alharbi, Raghad Hassan Sanyi, Esam I Azhar. Bacteria and host: what does this mean for sepsis bottleneck?[J]. World Journal of Emergency Medicine, 2025, 16(1): 10-17.
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URL: http://wjem.com.cn/EN/10.5847/wjem.j.1920-8642.2025.001
Table 1.
Spectrum of bacteria causing sepsis in different patient groups
| Patient group | Bacteria | Reference |
|---|---|---|
| Neonates | ||
| Early onset (within the first 72 h) | Coagulase-negative staphylococci | [ |
| Klebsiella pneumonia | [ | |
| Group B Streptococcus | [ | |
| Escherichia coli | [ | |
| Listeria monocytogenes | [ | |
| Streptococcus pneumoniae | [ | |
| Late onset (after 72 h) | Coagulase-negative staphylococci, gram-negative bacilli, Enterobacteriaceae, and both methicillin- sensitive and methicillin-resistant Staphylococcus aureus | [ |
| Children | Staphylococcus, Streptococcus, Pseudomonas, and Meningococcus | [ |
| Haemophilus influenza | [ | |
| Proteus mirabilis | [ | |
| Adults | Escherichia coli | [ |
| Staphylococcus aureus | [ | |
| Pseudomonas spp, Acinetobacter spp, Enterobacter spp | [ | |
| Immunocompromised adults | Community acquired gram-negative bacteria, Staphylococcus aureus, gram-positive cocci (group A-β hemolytic Streptococcus that produces pyrogenic exotoxin) | [ |
Figure 1.
Schematic presentation of parallel dynamics of selective pressures experienced by pathogens, which produce so-called bottlenecks, and the quality of the systemic inflammatory response. Recent experimental evidence has led to the development of a new sepsis model, challenging the traditional sepsis inflammatory concept in which an initial hyper-inflammatory response is followed by an immunosuppressive phase. This new sepsis model suggests the existence of a mixed inflammatory (heterogeneous) response in the initial phase of septicaemia.[69] The scale of the inflammatory response in sepsis can create a hostile environment for pathogens, applying strong selection pressure on the bacterial population (inoculum). This pressure may continuously result in a “bottleneck” effect, reducing the overall diversity of the bacterial population by allowing only specific clones with traits that enable them to survive immune assault to persist and proliferate. These surviving clones often possess adaptations, such as increased virulence factors or resistance to host defenses, which provide them with a survival advantage against immune system attack. Each pathogen is depicted as a colored sphere, with different colors representing distinct markers. The pro-inflammatory response is represented by the red line and red gradient, whereas the anti-inflammatory response is represented by the blue line and blue gradient.
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