The immunolimulus (IML) assay system uses solid-phase endotoxin antibodies to capture lipopolysaccharide (LPS), which is then quantified by a modification of the chromogenic limulus amebocyte lysate (CLAL) method. Monoclonal antibodies (MAbs) reactive with selected 0 antigen serotypes of Escherichia coli (018) and Salmonella typhimurium (0)(1)(2)(3)(4)(5)(6)(7)(8)(9)12), when used in the IML, were shown to be highly specific in detecting their respective endotoxins in purified form and in plasma samples from experimentally infected animals. A murine MAb that was broadly cross-reactive with E. coli, Salmonella, and Shigella endotoxins also proved to be highly effective in the IML assay for capturing LPS molecules from both E. coli and S. typhimurium strains. These results indicate that IML assays can detect smooth-type enterobacterial endotoxins in plasma and suggest that such assays have potential for use in the rapid diagnosis of sepsis and endotoxemia caused by different enterobacterial species.As many as 600,000 episodes of sepsis occur annually in the United States and about half of these cases are associated with positive blood cultures [I]. About half of all cases of sepsis are thought to be caused by gram-negative organisms [2] and the overall case-fatality rate associated with these infections is '"'-' 35% [3]. The incidence of severe infections caused by gram-negative bacteria has clearly increased during the past decade, most likely as the result of both the better survival of severely compromised patients and the greater use of invasive techniques in modern medicine. Accordingly, septic shock is one of the leading causes of mortality in hospitalized patients in the United States.Despite advances in rapid diagnostic methods used in microbiology, the diagnosis of bacteremia and sepsis caused by gram-negative bacteria is still based on conventional and time-consuming blood culture methods. The need to develop a more rapid method for detection of gram-negative septicemia and endotoxemia is underscored by the imminent introduction of new and expensive antiinfective therapies, including endotoxin-binding proteins [4,5] directed an tibodies or inhibitors [6]. Only certain su bgrou ps of patients with sepsis or septic shock syndrome will realize benefits from these new therapies, and thus screening and identification of these particular persons is essential for both medical and economic reasons [7].New diagnostic methods for detecting bacterial endotoxin have been investigated in our laboratory [8,9], culminating in the development ofa rapid method for the detection of the lipooligosaccharide (LOS) of Haemophilus influenzae type b (Hib). This immunolimulus (IML) assay used Hib LOS-specific monoclonal antibodies (MAbs) in a solid-phase system to capture Hib LOS present in plasma samples from experimentally infected animals [10]. This capture step provided the necessary specificity for this method, while the requisite sensitivity was obtained by the use of the chromogenic limuIus amebocyte lysate (CLAL) assay...