Development Of Septic Complications Research Articles

The Use of Laser Technology and Aquacomplex Titanium Glitserosolvat in the Treatment of Chronic Osteomyelitis

Хронический остеомиелит остается одной из наиболее сложных проблем гнойной хирургии, что связано, в том числе, с вы-сокой частотой встречаемости, составляющей до 6% в структуре патологии опорно-двигательной системы и 6,8–12% вструктуре гнойно-септических заболеваний, высоким риском развития септических осложнений и рецидивов, инвалидиза-ции, достигающей 55% случаев.Целью исследования явилось улучшение результатов лечения хронического остеомиелита путем применения лазерныхтехнологий и аквакомплекса глицеросольвата титана.Материалы и методы. Экспериментальные исследования проведены в 5 группахна 175 белых крысах с хроническим остео-миелитом: 2-х контрольных и 3-х опытных. 1-ю контрольную группу составили животные без лечения. Во 2-й контрольнойи опытных группах проводилась хирургическая санация гнойного очага. В 1-й опытной группе санация костной полостибыла дополнена применением низкоинтенсивного лазерного облучения. Во 2-й опытной группе выполнялось введение в кост-ную полость аквакомплекса глицеросольвата титана. В 3-й опытной группе – обработка костной полости низкоинтен-сивным лазерным излучением с последующим введением в нее аквакомплекса глицеросольвата титана. В ходе выполненияработы применяли клинические,гематологические, микробиологические и рентгенологические методы исследования.Результаты и их обсуждение. Моделирование хронического остеомиелита по разработанной методике позволяло к 31-мсуткам сформировать патологический процесс со свищами с гнойным отделяемым, что подтверждалось данными клини-ческих, микробиологических и рентгенологических исследований.Выводы Разработанный метод комплексного лечения хронического остеомиелита, основанный на сочетанном примене-нии лазерных технологий и аквакомплекса глицеросольвата титана способствовал сокращению сроков закрытия раневогодефекта, нормализации общего состояния и двигательной активности; нормализации окружности бедра поврежденнойконечности, показателей свободнорадикального окисления.

The etiologic structure and biologic characteristics of agents of infections of bloodstream.

As before, the infections of blood flow remain actual because of absence of universal approaches to their diagnostic and high lethality. Taking into account the fact that most frequently the sepsisogenic strains are selected in blood, studying of biological characteristics of hemocultures in comparison with strains isolated from other biotopes is very important for understanding the mechanisms of survival of pathogens in blood and prognosis development of septic complications. The article presents the results of microbiological analysis of blood carried out in multi-field clinic of Khanti-Mansiisk during 2007-2015. The following biological characteristics of S.aureus, E.coli, P.aeruginosa, C.albicans: hemolytic, catalase, anti-lysozyme, anti-complementary, biofilm forming, activity of hemocultures and strains isolated from other biotopes. The detection of hemolytic, catalase, anti-lysozyme, anti-complementary activities was implemented using photo-metric technique by capacity to lyse/inactivate corresponding substrate. The biofilm forming activity was evaluated according alteration of contact angle of moistening of surface of biofilm. The priority pathogens of infections of blood stream are coagulase-positive staphylococci - 38.3% (S.aureus), coagulase-negative staphylococci (S.epidermidis, S.hominis etc.), enterobacteria - 12.3% (E.coli, K.pneumonia), Pseudomonas aeruginosa - 4.1%, among fungi - C.albicans (2.5%). It is demonstrated that, in comparison with strains isolated from other biotops, hemocultures have statistically reliable higher values of catalase, anti-lysozyme, anti-complementary, biofilm forming activities. The conclusion is made concerning significance of these biological characteristics of pathogens for their survival in blood. It is proposed to use these indices as markers of sepsisogenic strains in prognosis of generalization of inflectional process.

The effect of brain injury on the inflammatory response following severe trauma

IntroductionThe inflammatory response is an important part of the pathophysiology of severe injury and, in particular, of severe traumatic brain injury (TBI). This study evaluates the inflammatory course following major trauma and focuses on the effect of severe TBI on inflammatory markers. Material and methodsThis was a retrospective analysis of prospectively collected data in 123 severely injured (ISS ≥16) trauma patients. The study cohort was divided into patients with isolated TBI (Head AIS ≥3, all other AIS <3), polytraumatized patients with severe TBI (Head AIS ≥3; AIS of other body area ≥3; Polytrauma+TBI) and polytraumatized patients without TBI (Head AIS <3; Polytrauma). Levels of inflammatory markers (Interleukin-6 [IL-6], C-reactive Protein [CRP], leukocytes) measured upon arrival and through hospital days 1–3 were compared between the groups. ResultsOn admission and through hospital day 3, IL-6 levels were significantly different between the 3 groups (admission: isolated TBI vs. Polytrauma+TBI vs. Polytrauma; 94±16 vs. 149±20 vs. 245±50pg/mL; p<0.05). Interleukin-6 levels peaked on hospital day 1 and declined thereafter. C-reactive protein and leukocyte counts were not significantly different between the cohorts on arrival and peaked on hospital day 2 and 1, respectively. In patients with severe TBI, admission IL-6 levels significantly predicted the development of septic complications (ROC analysis, AUC: 0.88, p=0.001, 95% CI: 0.79–0.97) and multiple organ dysfunction (ROC analysis, AUC: 0.83, p=0.001, 95% CI: 0.69–0.96). ConclusionSevere TBI reduced the inflammatory response following trauma. Significant correlations between admission IL-6 values and the development of MOF, sepsis and the neurological outcome were found in patients with TBI.

English

and the society should recognize this challenge. The solution to the problem is implementing a spectrum of injury central activities including surveillance, prevention and treatment for the injured. Blunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. Many injuries are missed during the initial assessment, examination and treatment period. The frequent causes of increased morbidity and mortality are missed intra-abdominal injuries and concealed hemorrhage, especially in those who survive the initial phase after an injury. Physical examination findings are notoriously unreliable. Various trauma scores and pathological tests have been developed to determine the prognosis and outcome. Serum levels of thyroid have come out as good predictors for mortality and development of septic complications in recently injured patients. These may prove to be effective parameters in the treatment and prognostication of the patients with injury. The observed thyroid hormone abnormalities do not indicate thyroid disease, but seem to represent a response to the underlying illness, as these invariably disappear with recovery from underlying illness. Nonthyroidal illness syndrome (NTIS). 2-4 NTIS has been depicted in about 70% of hospitalized patients for different diseases. 4 In a very recent paper in unselected ICU patients, free T 3 (fT 3) was the most powerful and the only independent predictor of ICU mortality, with a prognostic improving value when added to APACHE II score. 5

Gastric Cancer Immunotherapy: An Overview

Gastric adenocarcinoma is the third most common cancer and the second most common cause of death due to cancer worldwide. Surgery is still the major prognostic factor for gastric cancer. Patients who could not be resected have a poor prognosis with survival ranging from 3 to 11 months. There is evidence that surgical operations can cause a variety of immunological disturbances in man both in vivo and in vitro. The postoperative changes in the systemic immune response are proportional to the degree of surgical trauma leading to a generalized state of immunosuppression, which is implicated in the development of septic complications and provided a “fertile soil” for tumor cell metastasis. Immunotherapy may be a potentially promising alternative strategy for gastric cancer. In early clinical trials, systemic immunotherapy included both active vaccination directed against defined tumor-associated antigens expressed in gastric carcinoma cells and passive administration of IL-2 with some evidence of regression of metastatic gastric cancer. Other studies have applied immunotherapy in the adjuvant setting with equally promising results. For example, OK-432, a streptococcal preparation, demonstrated marginal improvement in survival for patients with stage III gastric cancer and a meta-analysis of centrally randomized controlled clinical trials indicated a significant survival benefit with combination OK-432 and chemotherapy compared to chemotherapy alone (p 0.05). Additional data suggesting a biological and clinical benefit of subcutaneous, preoperative administration of low-dose IL-2 in colon cancer encouraged us to evaluate low-dose IL-2 therapy in the neoadjuvant setting for patients with gastric adenocarcinoma who undergo surgery and to evaluate its effects on systemic and tumor infiltrating lymphocyte numbers. We also sought to determine if neoadjuvant low-dose IL-2 could influence the clinical outcome for patients undergoing gastric resection for cancer. We report the biological, histological and clinical results with the full accrual of patients and a median follow-up of 51 months.

C-reactive protein in the diagnosis of postoperative infection in pediatric patients: a prospective observational study of 103 patients

Background Surgical stress elicits a systemic inflammatory response syndrome that contributes to the development of septic complications. C-reactive protein (CRP) is an acute phase protein released in inflammatory states. To analyze the usefulness of CRP as a marker of infection in surgical pediatric patients, we analyzed its kinetics in these patients in comparison with usual markers, such temperature, leukocytes, or fibrinogen. Methods One hundred three pediatric patients undergoing major surgery were enrolled consecutively in this observational study. C-reactive protein, leukocytes, neutrophils, platelets, fibrinogen, glycemia, and temperature were determined daily after surgery. Patients were classified as infected or not infected. Sensitivity, specificity, positive predictive value, negative predictive value, efficiency, precocity, positive likelihood ratio, and number of subjects to be treated were calculated. Results Peak in CRP was detected at 48 ± 24 hours. C-reactive protein was higher in the infected group from the first day, with significant differences between groups from the second day. Best cutoff for detecting infection was increases in CRP of 11 mg/dL in 48 hours, with a sensitivity of 87%, specificity of 89%, precocity of 1.7 days (0.82-2.54), number of subjects to be treated of 1.7 (1.4-2.6), and positive likelihood ratio of 7.9. Application of other markers alone or in combination did not surpass the sensitivity, specificity, or precocity for increases in CRP of 11 mg/dL in 48 hours. Conclusions Increases of CRP constitute an easy and cheap prognostic alert system and may be used to establish strategies aimed to detect infection in surgical pediatric patients.

Factors Associated With Septic Complications After Restorative Proctocolectomy

Few studies have evaluated factors that may be associated with the development of septic complications after restorative proctocolectomy. Therefore, the aim of this study is to evaluate preoperative and operative factors that might be associated with septic complications after restorative proctocolectomy. Patients developing abdominal and pelvic septic complications after restorative proctocolectomy were identified from a prospective database. Patients with subclinical leaks and ileostomy closure leak were not included in the septic complication group. A multivariable logistic regression model for sepsis was constructed using a forward stepwise selection with entry criterion of P < 0.05. From 1983 to 2007, 3233 patients (56% male) were included in the database. Eight-four percent (2597) of patients underwent proximal diversion. Two hundred patients (6.2%) developed septic complications within 3 months of restorative proctocolectomy or within 3 months of ileostomy closure. On multivariate analysis, body mass index > 30 (P = 0.02, OR = 1.77), final pathologic diagnosis of ulcerative/indeterminate colitis (P = 0.02, OR = 2) or Crohn's disease (P = 0.02, OR = 3.6), intraoperative (P = 0.02, OR = 1.6), and postoperative transfusions (P = 0.01, OR = 1.9) were all independently associated with septic complications. We also demonstrated an independent association among individual surgeons (P = 0.04) with decreased septic complications. Body mass index greater than 30, final pathologic diagnosis of ulcerative/indeterminate colitis or Crohn's disease, intraoperative and postoperative transfusions, and surgeon were all independent factors associated with septic complications after restorative proctocolectomy.

Sever Sepsis After Probiotic Treatment With Escherichia coli NISSLE 1917

To the Editors: We report a case of an eutrophic preterm infant with a gestational age of 28 weeks and a birth weight of 935 g. The early postnatal phase was uncomplicated. On postnatal day 13, the infant developed gastroenteritis due to a rotavirus and adenovirus coinfection. A blood culture had no growth. To facilitate the physiologic intestinal bacterial flora on day 15 of life, we initiated a probiotic treatment with Escherichia coli NISSLE 1917 in the recommended dosage for this age group (1 mL once a day), with an immediate positive effect on the oral feeding. On postnatal day 25, a dramatic deterioration occurred with the infant showing a sepsis syndrome with fever, apnea attacks and hypotension. Blood cultures yielded E. coli, which was showing pulsed field gelelectrophoresis to be E. coli Nissle 1917 with clonal identity to the strain used therapeutically (Fig. 1). After intensified therapy with vasopressors, antibiotic treatment active against the isolated strain (meropenem in combination with vancomycine because of the central venous catheter), and intravenous immunoglobulins the patient stabilized and at 10 weeks of age was discharged in good clinical condition.FIGURE 1.: Result of the pulsed field gel electrophoresis. Lane 1: E. coli strain NISSLE 1917. Lane 2: E. coli strain isolated of the blood culture.Colonization with potentially pathogenic Gram negative bacteria is a risk factor for the development of necrotizing enterocolitis. Therefore, probiotics as live microbial supplements in preterms are used with the objective to support the intestinal colonization as well as to prevent infections or side effects of antibiotic drugs.1 It is unknown whether probiotic treatment increases or decreases the risk of invasive infection in preterm infants weighing less than 1500 g. The safety of this therapy is uncertain. Because of the immaturity of the gastrointestinal tract and of the local and systemic immune system in preterm infants the risk of systemic infections is increased. In a small study with 27 healthy newborns, E. coli strain NISSLE 1917 colonized the intestines within a few days and was well tolerated.2 Despite the fact that many studies have shown that E. coli NISSLE can replace pathogenic bacteria in the intestinal flora by means of intensive adherence to epithelial cells, analysis of the genomic structure has revealed a potential pathogenicity.3 Sepsis associated with probiotic supplementation in preterm infants with a very low birth weight (<1500 g) has not been previously reported. The immaturity of the immune system as well as the gastrointestinal tract combined with an increased permeability of the intestinal wall related to infection with rotavirus and adenovirus resulting in translocation of bacteria from the mucous membranes to the blood stream. After the neonatal period the probiotic prophylaxis is associated with an increased risk of sepsis in patients with severe acute pancreatitis and AIDS.4,5 In infancy, only a few case reports exist describing sepsis or meningitis complicated by Lactobacillus GG and Saccharomyces cerevisiae independent of probiotic supplementation.6,7 All cases of sepsis related to probiotics have occurred in patients with underlying immune compromise or chronic disease. Many case reports of probiotic sepsis describe patients with preexisting intestinal pathology, a common indication for probiotic use, but also associated with an increased risk of probiotic translocation from the intestinal mucosa. The presence of a central venous catheter is also a frequent finding and is considered as a possible source of sepsis. Studies with athymic neonatal mice have shown that the colonization with probiotics can lead to increased mortality.8 This finding suggests that the immaturity of the immune system in preterm infants put them at particularly high risk for probiotic-associated sepsis. The present case report should prompt a discussion of pros and cons of probiotic use. Additional systematical investigations and well organized clinical studies are needed to clarify risk factors for the development of septic complications after a treatment with probiotics. Katrin Guenther, MD Eberhardt Straube, MD Wolfgang Pfister, MD Albrecht Guenther, MD Axel Huebler, MD Department of Pediatrics Friedrich-Schiller University Jena, Germany

Kinetics of C-reactive protein, interleukin-6 and -10, and phospholipase A2-II in severely traumatized septic patients

Injury-induced anergy is one of the key factors contributing to trauma victims' high susceptibility to sepsis. This group of patients is mostly of young age and it is therefore essential to be able to predict as accurately as possible the development of septic complications, so appropriate treatment could be provided. The aim of this study was to assess kinetics of interleukin (IL)-6 and -10, phospholipase A2-II and C-reactive protein (CRP) in severely traumatized patients and explore the possibilities for early detection of potentially septic patients. This prospective study included 65 traumatized patients with injury severity score (ISS) > 18, requiring treatment at surgical intensive care units, divided into two groups: 24 patients without sepsis and 41 patients with sepsis. C-reactive protein, IL-6 and -10 and phospholipase A2 group II, were determined within the first 24 hours, and on the second, third and seventh day of hospitalization. Mean values of IL-6 and phospholipase A2-II in the patients with and without sepsis did not show a statistically significant difference on any assessed time points. In the septic patients with ISS 29-35 and > 35 on the days two and seven a statistically significantly lower level of IL-10 was found, compared with those without sepsis and with the same ISS. C-reactive protein levels were significantly higher in septic patients with ISS 18-28 on the first day. On the second, third and seventh day CRP levels were significantly lower in the groups of septic patients with ISS 29-35 and > 35, than in those with the same ISS but without sepsis. Mean levels of CRP on the first day after the injury may be useful predictor of sepsis development in traumatized patients with ISS score 18-28. Mean levels of CRP on the days two, three and seven after the injury may be a useful predictor of sepsis development in traumatized patients with ISS score more than 28. Mean levels of IL-10 on the second and seventh day after the injury may be a useful predictor of sepsis development in traumatized patients with ISS score > 28.

Estudio comparativo de las meningitis por Staphylococcus aureus y Staphylococci coagulasa negativo en adultos

Staphylococcus spp. rarely cause community-acquired acute bacterial meningitis (ABM), but they are a frequent cause of nosocomial meningitis. AIMS. We describe and conduct a comparative analysis of ABM due to S. aureus and coagulase-negative (CoN) Staphylococci in adults. We reviewed the medical records of patients aged 14 or over who had been diagnosed with ABM, including those with a positive cerebrospinal fluid (CSF) culture for Staphylococcus spp. Forty cases were included (28% of the ABM), 12 due to S. aureus and 28 due to CoN Staphylococci. Incidence increased over time: 1.9% in the first third of the study, 22.9% in the second and 19.4% in the third (p = 0.003). In 67% of cases it was nosocomial and post-operative in 95%. Neurosurgical devices (74%) and recent neurosurgery (26%) were the risk factors, and both associated 61%. Clinical signs and symptoms and alterations to CSF were similar in both groups, but bacteraemia (60% versus 20%) and the development of complications were more frequent in infections due to S. aureus. Overall mortality rate was above 15%, and was higher in infections due to S. aureus (67% versus 0%). Mortality was also associated with spontaneous acquisition of the infection (25% versus 0%), the development of septic complications (37% versus 6%), bacteraemia (62% versus 19%) and not withdrawing or changing the neurosurgical device (60% versus 0%). Staphylococcus spp. are a frequent cause of ABM in hospitals with neurosurgery, especially in the post-operative period following neurosurgical procedures and/or in carriers of CSF drainage devices. Prognosis in infections caused by CoN Staphylococci is favourable, in contrast to the high mortality rate caused by S. aureus.

Viral reactivation is not related to septic complications after major surgical resections

Anastomotic leakage and septic complications are the most important determinants of postoperative outcome after major surgical resections. Malignant diseases and surgical trauma can influence immune responses and the ability to react against infectious factors, such as bacteria and viruses. Comparable immune suppression can cause viral reactivation in transplantation and trauma patients. In this prospective study, patients who underwent major surgical resections for oesophageal or pancreatic cancer were investigated for the potential involvement of viral reactivation in the development of septic complications. 86 patients (40 oesophageal resections, 27 pancreatic resections, 19 surgical explorations) were included. Viral antigens, viral DNA, antibodies against viral structures (IgG, IgM, IgA) and, in part, viral cultivation were performed for CMV, EBV, HSV1, HSV2, HZV6 and VZV in serum, urine, sputum and swabs from buccal mucosa preoperatively and at postoperative days 1, 3 and 5. Test results were compared with the postoperative outcome (30-day morbidity, in-hospital mortality) and clinical scores (SOFA, TISS). For statistical analyses Student's t-tests and Chi2-tests were used. The overall complication rate was 19.8% (30-day morbidity) with an in-hospital mortality of 1.2% (1/86 patients). Postoperatively, anti-CMV-IgG titres were significantly reduced (p<0.05) and remained suppressed in patients with septic complications. Anti-CMV-gB-IgG were also reduced, but showed considerable interindividual differences. Anti-CMV-IgA and -IgM did not show significant alterations in the postoperative course. In addition, direct viral detection methods did not support viral reactivation in patients in any of the investigated groups. The reduction of anti-CMV antibodies is likely caused by an immune suppression, specifically by reduced B-cell counts after major surgical interventions. Viral reactivation, however, did not occur in the early postoperative period as a specific risk for septic complications.

Circulating Dendritic Cells and Development of Septic Complications After Pancreatectomy for Pancreatic Cancer

To investigate whether circulating dendritic cells in patients with pancreatic cancer is a risk factor for septic complications after pancreatectomy. Retrospective study. University hospital. Forty-one patients with pancreatic cancer who underwent pancreatectomy from May 2001 to July 2005. Patients were divided into 2 groups depending on whether or not they had a development of postoperative septic complications. Dendritic cell, natural killer cell, and CD4(+) T-cell, and CD8(+) T-cell counts were measured preoperatively in each patient. Clinicopathologic parameters and immune parameters for each patient, operation, and tumor were compared between the 2 groups. Preoperative risk factors for postoperative septic complications were determined using logistic regression analysis. Circulating dendritic cell count before pancreatectomy in patients with septic complications postoperatively for pancreatic cancer was significantly lower than in patients without septic complications. Multivariate analysis indicated that preoperative circulating dendritic cell count was the only predictive value among the diverse clinical parameters tested in relation to the development of septic complications. Notably, when the circulating dendritic cell count was less than 10.0 x 10(3)/mL in the peripheral blood, the risk of developing postoperative septic complications markedly increased. In such cases, the sensitivity, specificity, positive predictive value, and negative predictive value of total circulating dendritic cell count were as high as 80%. In patients with pancreatic cancer, low preoperative circulating dendritic cell count (< 10.0 x 10(3)/mL) is a significant risk factor for the development of septic complications after pancreatectomy.

Circulating Dendritic Cells and Development of Septic Complications After Pancreatectomy for Pancreatic Cancer—Invited Critique

Circulating Dendritic Cells and Development of Septic Complications After Pancreatectomy for Pancreatic Cancer—Invited Critique

Decreased monocyte human leukocyte antigen-DR expression after severe burn injury: Correlation with severity and secondary septic shock

Severe thermal injury causes immune dysfunctions involving both pro- and anti-inflammatory mechanisms. It subsequently leads to a state of immune deficiency that shares some similarities with sepsis-induced immunosuppression. A hallmark of the latter is established by decreased monocyte human leukocyte antigen-DR (mHLA-DR) measurements. The main objective of the current study was to characterize the appearance and the duration of low mHLA-DR expression after severe burn as well as to determine its correlation with mortality and septic complications. Observational study. Burn unit (intensive care unit) in a university hospital. Severe burn patients (total burn surface area >30%, n = 14) and healthy individuals (n = 29). None. Patients were immunologically monitored during 15 days. We quantified mHLA-DR expression with a standardized flow cytometry protocol. Every patient presented with decreased mHLA-DR expression at days 2-3 after burn. Then, from days 4-6, this expression increased in patients who would survive whereas it remained low in nonsurvivors. As early as days 7-10 after burn, patients who were going to develop secondary septic shock exhibited significantly lower mHLA-DR expression in comparison with patients recovering without severe septic complications. Using quantitative reverse transcriptase-polymerase chain reaction, at days 4-6, we found that the RNA level of the nonpolymorphic HLA-DRA chain and the transcription factor class II transactivator were also significantly decreased compared with healthy controls; however, plasma cytokines (interleukin-6, tumor necrosis factor-alpha, and interleukin-10) did not provide any significant prognostic information. Severe burn injury induced a marked reduction in mHLA-DR expression at both protein and messenger RNA levels. Its persistent decrease was associated with mortality and the development of septic complications.

The Influence of Local Instillation of Fusidic Acid on the Development of Microbial Complications After Lung Resection

The efficacy of local instillation of fusidic acid in the prevention of post-surgical microbial complications during various types of lung resection was studied. Four hundred ninety two consecutive patients who underwent 504 thoracotomies for non-small cell lung carcinoma during April 1998-May 2004 were reviewed. The 290 patients of the first period who underwent 298 thoracotomies received a chemoprophylactic regimen of intravenous cefuroxime while the 202 patients of the second period who underwent 206 thoracotomies were additionally treated with fusidic acid, irrigated with local instillation into the pleural space, for the prevention of postoperative septic complications. Patients were followed postoperatively for development of septic complications (empyema and bronchopleural fistula) as well as of pneumonia and wound infection. Seventeen patients (5.7%) of the first period developed empyema and 13 fistula (4.4%), whereas only 2 patients (1.0%) of the second period developed empyema and fistula (OR = 5.876; 95% CI, 1.343-25.716; P = 0.008 and OR = 4.193; 95% CI, 1.003-20.130; P = 0.034, respectively). Cases of pneumonia decreased, but not significantly, from 21 (7.0%) during the first period to 9 (4.4%) during the second period (OR = 1.613; 95% CI, 0.724-3.593; P = 0.257) while cases of wound infection decreased significantly from 19 (6.4%) to 2 (1.0%) (OR = 6.567; 95% CI, 1.513-28.510; P = 0.003). During the first period 23 pathogens were found from cases of empyema and 73 pathogens from cases of pneumonia and wound infection, whereas during the second period 3 and 18 pathogens were respectively found (OR = 5.3; 95% CI, 1.570-17.888; P = 0.003, and OR = 2.804; 95% CI, 1.628-4.838; P <0.001, respectively). These results indicate that local instillation of fusidic acid in the pleural space prior to lung resection seems effective in reducing the rate of septic complications as well as of wound infections.

Evidence for intestinal oxidative stress in patients with obstructive jaundice

Obstructive jaundice results in failure of the intestinal barrier with consequent systemic endotoxemia associated with septic complications. We have recently shown that gut barrier failure in experimental obstructive jaundice is associated with high intestinal oxidative stress. This study was undertaken to investigate whether oxidative alterations occur in the intestinal mucosa of patients with obstructive jaundice. Fifteen patients with malignant biliary obstruction and no signs of cholangitis and 15 control patients were subjected to duodenal biopsy to assess intestinal oxidative stress, estimated by lipid peroxidation (malondialdehyde - MDA) and glutathione redox state [reduced glutathione (GSH), glutathione disulphide (GSSG) and GSH/GSSG ratio]. In addition, mucosal biopsies were examined histologically and intestinal mucosal protein content was determined biochemically as an index of intestinal trophic state. Patients with obstructive jaundice presented high levels of intestinal oxidative stress, with significantly increased lipid peroxidation (P < 0.001). Glutathione redox state was also suggestive of high intestinal oxidative stress in jaundiced patients, indicated by significantly decreased GSH (P = 0.001) and GSH/GSSG ratio (P = 0.006) and increased GSSG (P = 0.026). Histological examination showed a mild infiltration of the lamina propria by chronic inflammatory cells in obstructive jaundice, whereas duodenal architecture remained intact and epithelial continuity was retained. Duodenal mucosa was atrophic in jaundiced patients as indicated by a significant reduction of mucosal protein content compared with controls (P = 0.001). Among oxidative stress parameters, intestinal GSH exhibited a significant positive correlation with mucosal protein content (r = 0.588, P = 0.021). Obstructive jaundice in humans induces intestinal oxidative stress, which may be a key factor contributing to intestinal barrier failure and the development of septic complications in this patient population.

Can single nucleotide polymorphisms in innate immune receptors predict development of septic complications in intensive care unit patients?*

Critical Care Medicine: March 2005 - Volume 33 - Issue 3 - p 695-696 doi: 10.1097/01.CCM.0000155998.92099.C2

Feasibility and safety of needle catheter jejunostomy for enteral nutrition in surgically treated severe acute pancreatitis.

The role of the gut in the development of septic complications and promising clinical results have led to a shift from the parenteral to the enteral route for nutrition support of patients with acute pancreatitis. In patients undergoing surgery for severe necrotizing pancreatitis, the application of a needle catheter jejunostomy might be useful. However, there is a shortage of clinical data on its feasibility and possible harmful effect. Between January 1999 and December 2002, 13 patients were operated for severe acute necrotizing pancreatitis. At the time of surgery, needle catheter jejunostomy was performed using a standard technique. Enteral nutrition was initiated without a strict protocol by feeding small amounts of a standard diet and carefully monitoring patient tolerance. As long as necessary, patients were also fed parenterally in order to achieve target caloric goals. No major tube- or feeding-related complications were observed. A single case of tube dislodgement caused by manipulation during relaparotomy for lavage occurred and was rectified during the same operation. In patients undergoing surgery for severe acute pancreatitis, needle catheter jejunostomy for long-term enteral nutrition can be applied with no additional risk.

THE EFFECT OF RECENT TRAUMA ON SERUM COMPLEMENT ACTIVATION AND SERUM C3 LEVELS CORRELATED WITH THE INJURY SEVERITY SCORE

Purpose: The objective of this prospective pilot study was to estimate serum C3 levels and complement activation within 12 hours of injury and to correlate them with abbreviated injury score (AIS) so as to predict the outcome of injury in terms of mortality or sepsis. Methods : The test group (n=30) of patients with < 12 hours of injury were assessed by the AIS-80 and compared with a control group (n=10). Serum C3 levels were estimated by the single radial immunodiffusion technique and complement activation by both two-dimensional and counter immuno-electrophoresis. Statistical analysis was performed using the correlation regression analysis and the minimum discrimination information statistics (MDIS) analysis. Results: Serum C3 levels were not reduced in patients with injury severity score (ISS) < 12 (n=7). There was a statistically significant difference of serum C3 levels in patients with ISS between 12 and 29 (n=15) and in patients with ISS more than 29 (n=9). Complement activation also correlated well with ISS (p <0.05). Complement activation and serum C3 levels were found to influence subsequent development of septic complications in the post injury period, being significantly lower in patients who developed septic complications. Complement alterations in trauma patients were a direct result of the trauma since they were not seen in patients undergoing surgery. Conclusions: ISS is a good prognosticator of outcome of trauma and serum C3 levels and complement activation are good predictors for mortality and development of septic complications in recently injured patients. These may prove to be effective parameters in the management of the patients with injury.

The role of inducible nitric oxide synthase inhibitor, meropenem, and taurine in experimental acute necrotizing pancreatitis.

Translocation of bacteria from the gut is one of the most important factors in the development of septic complications and mortality in acute pancreatitis. To investigate whether S-methylisothiourea (SMT), taurine (TAU), and meropenem (MER) could effect bacterial translocation and the course of acute necrotizing pancreatitis. Seventy male Sprague-Dawley rats were studied. Rats were randomly allocated into seven groups. Acute pancreatitis was induced in group II (MER), group III (TAU), group IV (TAU + MER), group V (TAU + SMT), group VI (TAU + MER + SMT), and group VII (positive control) by retrograde injection of taurocholate into the common biliopancreatic duct. Group I rats (sham) received normal saline infusion into the common biliopancreatic duct as negative control. Rats were treated with drug combinations intraperitoneally for 48 hours after induction of pancreatitis. At the 48th hour of induction, all animals were killed, and specimens were collected. Bacterial translocation to peritoneum and pancreas in groups treated with MER were lower than in the other groups. Pancreatic tissue GSHpx and SOD levels were higher in all groups in comparison with levels in group VII. Pancreatic tissue MDA levels were also lower in all treatment groups except group II. The most favorable results were obtained in group VI (TAU + MER + SMT). Also, the lowest pathologic score between the groups in which acute pancreatitis developed was obtained in group VI. Addition of TAU and SMT to the treatment protocol for acute pancreatitis seems to improve the pathologic score and oxidative stress parameters. Also, antibiotherapy with MER decreases the risk of bacterial translocation.