Cell wall peptidoglycan stimulates IL-10 production in Staphylococcus aureus bacteremia (SaB) animal models, but clinical data are not available. This study evaluates the impact of intravascular bacterial cell numbers, i.e. the level of bacteremia, in patients at the time of clinical presentation on IL-10 production and its association with S. aureus bacteremia (SaB) mortality.
Blood and isolates were collected in 133 consecutive SaB patients. Serum IL-10 was quantified by an electrochemoluminescence assay. Bacterial inoculum was measured in patient sera with elevated (n=8) or low (n=8) IL-10 using a magnetic bacterial capture assay. S. aureus from these two groups were introduced into whole blood ex vivo to determine IL-10 production with variable inocula.
IL-10 serum concentration was higher in SaB patient mortality (n=27) versus survival (n=106) (median 36.0 pg/ml versus 10.4 pg/ml, respectively, p<0.001). Patients with elevated IL-10 more often had endovascular SaB sources. The inoculum level of SaB was higher in patients with elevated serum IL-10 versus patients with low IL-10 (35.5 versus 0.5 median cfu/ml, p=0.044). Ex vivo studies showed that 108cfu/ml yielded greater IL-10 compared to 103cfu/ml (4.4±1.8 versus 1.0±0.6pg/mL; p<0.01).
Elevated IL-10 serum concentrations at clinical presentation of SaB was highly associated with mortality. High intravascular peptidoglycan concentration, driven by a higher level of bacteremia, is a key mediator of IL-10 anti-inflammatory response that portends poor clinical outcome. Using IL-10 as an initial biomarker, clinicians may consider more aggressive antimicrobials for rapid bacterial load reduction in high-risk SaB patients.