iScience (Aug 2021)

Presence of 2-hydroxymyristate on endotoxins is associated with death in neonates with Enterobacter cloacae complex septic shock

  • Luis A. Augusto,
  • Nadège Bourgeois-Nicolaos,
  • Aude Breton,
  • Simon Barreault,
  • Enrique Hernandez Alonso,
  • Stuti Gera,
  • Véronique Faraut-Derouin,
  • Nada Semaan,
  • Daniele De Luca,
  • Richard Chaby,
  • Florence Doucet-Populaire,
  • Pierre Tissières

Journal volume & issue
Vol. 24, no. 8
p. 102916


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Summary: Enterobacter cloacae complex species are involved in infections among critically ill patients. After a recent E.cloacae outbreak of fulminant neonatal septic shock, we conducted a study to determine whether septic shock severity and its lethal consequence are related to structural features of the endotoxin (lipopolysaccharide [LPS]) of the strains isolated from hospitalized infants and more specifically its lipid A region. It appeared that the LPSs are very heterogeneous, carrying fifteen different molecular species of lipid A. The virulence was correlated with a structural feature identified by matrix-assisted laser desorption ionization–time of flight mass spectrometry and gas chromatography coupled with mass spectrometry: the presence of 2-hydroxymyristic acid as a secondary substituent in lipid A. This is the first published evidence linking LPS structural moiety to neonatal sepsis outcome and opens the possibility of using this fatty acid marker as a detection tool for high-risk patients, which could help reduce their mortality.