Bacterial Translocation Relationship with Enteral L-Glutamine and L-Alanine in Experimental Rat Burn Model

Abstract

Introduction and Objective: The aim of this experimental study is to research the effects of L-alanine and L-glutamine on liver, structural changes on small intestine, wound healing, and bacterial translocation which are being widely used on intensive care patients. Material and Method: 20 male Sprague Dawley rats which weigh 190-230 gr used in this study. Rats separated into two randomized groups. In accordance with experimental rat burn model, skin burn was created in every rat and both groups are fed equally for 21 days. Experimental group administered L-glutamine+L-alanine containing product (Dipeptiven®, Fresenius Kabi BadHamborg, Germany) for 5 ml/kg/day orally. At the end of 21st day all rats were sacrificed. Biopsy materials obtained from liver, small intestine, and burn wound and blood culture was taken under sterile conditions. In pathologic examination structural changes in tissues and wound healing was evaluated. In microbiologic examination, effects of L- glutamine and L-alanin on bacterial translocation are evaluated by comparing small instestine and blood cultures. Results: No structural difference was seen among small intestine biopsies between two groups. No liver damage was seen in experimental group while live biopsies showed grade 1 damage in control group. Epitelization and granulation was detected as better in pathologic examination of skin biopsies obtained from burn wound showed better in experimental group. Microbiologic examination showed bacterial replication in total of 4 rats from control group, two rats showed replication of S.aures in small intestine and blood culture and two rats showed replication of S. epidermidis in small intestine and blood culture. No replication was determined in any rats from experimental group. Conclusion: In the light of findings acquired from this study done with experimental rat burn model, we think that use of L-glutamine+L-alanin will have positive effects on wound healing and helps preventing the bacterial translocation in burn patients as a supporting product.Giris ve Amac: Bu deneysel calismanin amaci, yogun bakim hastalarinda siklikla kullanilan L-alanin+ L-glutaminin, karaciger, ince bagirsaktaki yapisal degisikliklere etkisi, yara iyilesmesine etkisi ve bakteriyel translokasyona etkisinin arastirilmasidir. Materyal ve Metod : Bu calismada 190-230 gr olan 20 adet erkek Sprague Dawley rat kullanildi. Deney, 2 grup uzerinde tasarlandi. Tum ratlarda, deneysel rat yanik modeline uygun olarak yanik olusturuldu ve her iki grup esit sartlarda 21 gun beslendi. Deney grubuna, 5ml/kg/gun L-glutamin+L-alanin iceren (Dipeptiven®, Fresenius Kabi BadHamborg, Almanya) preparat oral yolla verildi. 21 gunun sonunda tum ratlar sakrifiye edildi. Tum ratlardan steril sartlarda, karaciger, ince bagirsak, yanik yarasindan biyopsiler ve kan kulturleri alindi. Patolojik incelemede karaciger ve ince bagirsak dokularindaki yapisal degisiklikler ve yara iyilesmesi degerlendirildi. Mikrobiyolojik incelemede ince bagirsak ve kan kulturleri kiyaslayarak L- glutamin+L-alaninin bakteriyel translokasyona etkisi arastirildi. Bulgular : Iki grup arasinda ince bagirsak biyopsileri arasinda hicbir yapisal fark gorulmedi. Karaciger biyopsilerinde kontrol grubunda grade 1 hasarlanma mevcutken deney grubunda hasar tesbit edilemedi. Yanik yarasindan alinan cilt biyopsilerinin patolojik incelemesinde deney grubunda epitelizasyon ve granulasyonun daha iyi oldugu tesbit edildi. Mikrobiyolojik incelemede kontrol grubundaki iki ratin ince bagirsak ve kan kulturlerinde S.aureus, iki ratin ince bagirsak ve kan kulturlerinde de S.epidermidis olmak uzere toplamda dort ratta ureme tesbit edildi. Deney grubundaki hicbir ratin ince bagirsak ve kan kulturlerinde ureme olmadi. Sonuc: Deneysel rat yanik modelinde yapilan bu calismanin sonucunda elde ettigimiz verilere gore, L-glutamin+L-alanin kullaniminin, yanik hastalarinin yara iyilesmesine olumlu etkisi oldugu, ek olarak ta bakteriyel translokasyonu engell