## 4 Discussion
We also found lower levels of IL-1 on the third day of treatment, and a tendency to decrease the pro-inflammatory cytokine IL-6 in the TASE group. All these data would support the immunomodulatory role of the lyophilized garlic, thanks to its action in the inflammatory cascade [26], thus achieving the attenuation of sepsis and septic shock. Previous work has described the ability to suppress inflammatory signals of lipopolysaccharide (LPS) through the expression of anti-inflammatory genes, and the reduction in pro-inflammatory cytokines (IL-6 and MCP-1) [27]. The work of [PERSON] et al. [28] showed the immunomodulatory activity of garlic in an experimental sepsis model where clamping and blind puncture were performed to induce peritonitis. The authors described how the administration of methyl 3-formyl-4-methylpentanoate (a natural compound derived from garlic) led to the inhibition of apoptosis of lymphocytes in the spleen and significantly inhibited the production of pro-inflammatory cytokines such as TNF-\(\alpha\), IL-1B and IL-6. The production of TNF-\(\alpha\) and IL-6 stimulated by LPS was also strongly inhibited by the compound methyl 3-formyl-4-methylpentanoate sucrose in macrophages derived from mouse bone marrow [28]. In our study, we could not assess any significant difference on TNF-\(\alpha\) levels in the TASE group. The microbiological analysis showed how the blood cultures of the control group were positive for _E. coli_. This bacterium corresponded to the same inoculum with which sepsis was generated. However, no blood culture or peritoneal fluid were positive for _E. coli_ in the TASE-treated group. This result highlights the fact that the inoculum was sensitive to the antibiotic and coadjuvant treatments used. In fact, it is known that there is a 90% sensitivity of _E. coli_ to ceftaxone and only 65% sensitivity of _Klebsiella pneumoniae_. Despite these moderately high percentages, we are currently in a global state of alarm due to the increased resistance of several microorganisms to this antibiotic compared to previous studies [29]. Moreover, most of the blood and peritoneal fluid cultures in our antibiotic treatment group showed the presence of _Enterococcus faecalis_. This result could be explained by considering the broad-spectrum efficacy of ceftaxone on Gram-negative and some Gram-positive bacteria. This change of gastrointestinal microbiota would favor _Enterococcus faecalis_. One likely explanation for this selection is based on related studies in mice where LPS and flagellin from Gram-negative and anaerobic bacteria stimulated the production of RegIIIy in Paneth cells by interactions with Toll-like receptors. Paneth cells have an important role in the defense mechanisms of the gastrointestinal tract in several animal species, thanks to their secretions of lysozyme, phospholipase A2 and defensins [30]. RegIIIy is a C-type lectin receptor, capable of recognizing carbohydrates present on the surface of pathogens and is responsible of the internalization of the pathogen for antigen presentation and the induction of an immunological response. Thus, the level of RegIIIy maintains the balance between the bacteria that compose the intestinal microbiota and the host [31]. When ceftaxone used in our study killed the Gram-negative bacteria, it decreased the production of RegIIIy and facilitated the growth of Gram-positive coccus (i.e., _Enterococcus faecalis_). Then, those Gram-positive could cross the intestinal barrier and reach the systemic circulation, liver and more. Therefore, if the antibiotic treatment persists for a long time, there could be a potential risk of bacterial endocarditis. Few studies with animal models associate histological, clinical, and microbiological findings in intraperitoneal organs such as liver, peritoneum, and intestine after induced peritonitis. In this sense, our study tried to correlate those findings with the clinical response to a treatment based on a thiosulfinate-enriched garlic extract. Only [PERSON] et al.