ABSTRACT
Gram-negative bacterial infections account for as many as a half of documented infections in patients with sepsis, especially those who develop the serious sequelae of sepsis, multiple organ dysfunction. When the Limulus amebocyte lysate (LAL) assay is used to detect endotoxin in blood, two obstacles are encountered: the complex and poorly understood inhibitory factors present in blood, and the low levels of endotoxin in blood, which are often at the limit of test detection. While the quantification of endotoxin can be achieved by endpoint methods, the limitations of the technique, in contrast to a kinetic assay, should be recognized. Because the LAL assay is so highly sensitive, there has been no alternative assay against which to validate the results of plasma testing. The complications are associated with greatly increased mortality and are often refractory to conventional treatment including appropriate therapy for gram-negative sepsis.
