It is accepted that, during gram-negative sepsis, endotoxin plays a major pathophysiological role in the activation of different mediator cascades. However, previous clinical studies into the relevance of endotoxemia during abdominal sepsis mainly caused by gram-negative rods have produced inconsistent results. Although endotoxin can be routinely detected in the circulation, the correlation with clinical features is still lacking. In a new study, we not only detected endotoxin during peritonitis but we also demonstrated a clear association between the degree of endotoxemia and the clinical outcome. Furthermore, the observation of endotoxin release during surgical treatment should be kept in mind when discussing adjuvant therapeutic modalities for the treatment of peritonitis.

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