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In Reply Drs Sweeney and Kalil argue that our genomic analyses do not support the existence of immunosuppression. However, although the blood genomic response on ICU admission was not different between patients with sepsis who either did or did not develop an ICU-acquired infection, the gene expression signatures of both groups showed features of immune suppression. In addition, at the time of the ICU-acquired infection, blood leukocytes showed decreased expression of genes involved in glucose metabolism, suggestive of immune suppression.1
van Vught LA, Klouwenberg PMK, van der Poll T. Secondary Infection in Patients With Sepsis—Reply. JAMA. 2016;316(7):772. doi:10.1001/jama.2016.9279