Catecolaminas y bacterias: una interacción poco conocida pero clínicamente relevante, revisión integrativa de la bibliografía

Vélez-Páez, Jorge Luis; Tutín-Miniguano, Erick

doi:10.1016/j.acci.2025.05.001

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Resumen

Las catecolaminas, históricamente conocidas por su papel en la regulación cardiovascular y la respuesta al estrés, tienen interacciones biológicas directas poco conocidas con bacterias patógenas que llegan a modular variables infectológicas trascendentales, como el crecimiento, la virulencia y la resistencia a antibióticos de los patógenos.

El objetivo de esta revisión es develar la evidencia científica actual sobre esta relación, recalcando mecanismos como la inducción de sistemas de captación de hierro (sideróforos), la activación de sensores bacterianos y la promoción de biopelículas. Analizamos de manera enfática patógenos claves en enfermedades humanas como Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus y Enterococcus faecalis, cuya respuesta a catecolaminas puede exacerbar infecciones en pacientes críticamente enfermos. Además, se discuten las implicaciones clínicas, como un nuevo dilema terapéutico en el shock séptico (soporte vasopresor catecolaminérgico vs. exacerbación de la infección) y nuevas estrategias terapéuticas que derivan del entendimiento de la compleja interacción bacteria-catecolamina, como es el inicio temprano de vasopresores no catecolaminérgicos, inhibidores de virulencia, quelantes de hierro y terapias combinadas.

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Palabras clave:

Catecolaminas

Infecciones bacterianas

Sepsis

Resistencia bacteriana

Virulencia

Abstract

Catecholamines, historically known for their role in cardiovascular regulation and stress response, have poorly understood direct biological interactions with pathogenic bacteria, modulating key infectious disease variables such as pathogen growth, virulence, and antibiotic resistance.

The objective of this review is to uncover the current scientific evidence on this relationship, highlighting mechanisms such as the induction of iron uptake systems (siderophores), the activation of bacterial sensors, and the promotion of biofilms. We emphatically analyze key pathogens in human pathology such as Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Enterococcus faecalis, whose response to catecholamines can exacerbate infections in critically ill patients. In addition, clinical implications are discussed, such as a new therapeutic dilemma in septic shock (catecholaminergic vasopressor support vs. exacerbation of infection) and new therapeutic strategies that derive from the understanding of the complex bacteria-catecholamine interaction, such as the early initiation of non-catecholaminergic vasopressors, virulence inhibitors, iron chelators and combination therapies.

Keywords:

Catecholamines

Bacterial infections

Sepsis

Drug resistance, Bacterial

Virulence

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Catecolaminas y bacterias: una interacción poco conocida pero clínicamente relevante, revisión integrativa de la bibliografía

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