Endotoxin in sepsis: Time for a reappraisal?

Abstract

The role of endotoxin released from gram-negative bacteria in the pathogenesis of the sepsis syndrome is unclear. The release of endotoxin may be a marker for the transition of gram-negative organisms to cell-wall-deficient forms (L-forms) that can persist undetected despite antibiotic therapy directed against the organism with a cell wall. This transition could explain 2 phenomena in critically compromised patients. These L-forms cause organ failure and serve as a sanctuary from which cell-wall-intact revertants may arise.