GM-CSF to Decrease ICU Acquired Infections

Inclusion Criteria:

ICU patients presenting a severe sepsis or a septic shock associated with a sepsis-induced immunosuppression.

1. • Severe sepsis OR septic shock defined by the association of: at least 2 criteriaof Systemic Inflammation Response Syndrome (SIRS) a clinically or microbiologicallydefined infection and respectively at least one organ failure (level ≥ 2 in oneorgan failure of the SOFA score) OR the need of a vasopressor treatment (epinephrineor norepinephrine ≥ 0,25mg/kg/min for at least 6 hrs to maintain a systolic pressure ≥ 90 mmHg or a mean arterial pressure ≥ 65 mmHg).
2. • AND Sepsis-induced immunosuppression: reduced mHLA-DR levels (< 8,000 monoclonalantibodies (mAb) per cell at D3).

Exclusion Criteria:

1. • Therapeutic limitation

2. Evolutive hemopathy, neutropenia < 500/mm3, stemcell transplant

3. Solid tumor with on-going chemotherapy or radiotherapy

4. Human immunodeficiency virus (HIV) infection with CD 4 count < 200 cell/mm3

5. Immunosuppressive treatment (including corticosteroid at immunosuppressive dose : > 10 mg equivalent prednisolone and cumulative dose > 700 mg)

6. Primary immunodeficiency .

7. Extra corporeal circulation within one month

8. Recent cardio-pulmonary resuscitation (within the current clinical episode)

9. Patients admitted in ICU for extensive burns

10. Contraindications to sargramostim

11. Pregnant or lactating women

12. Participation to another interventional study.