Systemic Inflammatory Response Syndrome and Nosocomial Infection in Trauma

Hoover, L. Wayne; Bochicchio, Grant V.; Napolitano, Lena M.; Joshi, Manjari; Bochicchio, Kelly; Meyer, W.; Scalea, Thomas M.

doi:10.1097/01.ta.0000229052.75460.c2

Cited by 80 publications

(70 citation statements)

References 38 publications

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“…A recent report has shown that patients with blunt injuries (84%) and penetrating injuries (16%) developed a nosocomial infection in 45.4% of the cases (15). To determine whether decreased numbers of CD4-or CD8-expressing cells play a role in a subsequent infection, we continued our studies with CD4-or CD8-deficient mice using a physiologically relevant model of sepsis.…”

Section: Cd4 and Cd8 T-cell Numbers Are Decreased After Blunt Traumamentioning

confidence: 99%

Cd4-Expressing Cells Are Early Mediators of the Innate Immune System During Sepsis

Martignoni

Tschöp²,

Goetzman³

et al. 2008

Shock

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It is well established that the immune response to sepsis is mediated by leukocytes associated with the innate immune system. However, there is an emerging view that T lymphocytes can also mediate this response. Here, we observed a significant depletion of both CD4 and CD8 T cells in human patients after blunt trauma. To determine what effect the loss of these cells may have during a subsequent infection, we obtained CD4-and CD8-deficient mice and subjected them to cecal ligation and puncture (CLP). We observed that CD4 knockout (KO) mice showed increased CLP-induced mortality compared with CD8-deficient and wild-type (WT) mice especially within the first 30 h of injury. CD4 KO mice also exhibited significantly increased IL-6 concentrations after the CLP. The CD4 KO mice had an increased concentration of bacteremia as compared with WT mice. Antibiotic treatment decreased mortality in the CD4 KO mice as compared with no changes in the wild mice after CLP. Neutrophils isolated from septic CD4 KO mice showed decreased spontaneous oxidative burst compared with neutrophils taken from septic controls. We examined the role of IFN-γ by using mice deficient in this cytokine and found these mice to have significantly higher mortality as compared with WT mice. Finally, we detected a 2-fold increase in CD11b + cells that exhibited intracellular IFN-γ staining in the peritoneum of WT mice after CLP. The data suggest that CD4 + cells may facilitate the early clearance of bacteria by regulating neutrophils function possibly through an IFN-γ-dependent mechanism.

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Section: Cd4 and Cd8 T-cell Numbers Are Decreased After Blunt Traumamentioning

confidence: 99%

Cd4-Expressing Cells Are Early Mediators of the Innate Immune System During Sepsis

Martignoni

Tschöp²,

Goetzman³

et al. 2008

Shock

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“…It has been recently reported that ~45% of patients suffering blunt or penetrating trauma develop nosocomial infections [15]. To determine whether decreased numbers of γδ T cells mediate the immune response during a subsequent infection, we examined the response of γδ T cell-deficient mice in a physiologically relevant model of sepsis.…”

Section: γδ T Cell Numbers Are Decreased Following Blunt Traumamentioning

confidence: 99%

γδ T cells mitigate the organ injury and mortality of sepsis

Tschöp

Martignoni

Goetzman

et al. 2007

Journal of Leukocyte Biology

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Sepsis is a difficult condition to treat and is associated with a high mortality rate. Sepsis is known to cause a marked depletion of lymphocytes, although the function of different lymphocyte subsets in the response to sepsis is unclear. γδ T cells are found largely in epithelial-rich tissues, and previous studies of γδ T cells in models of sepsis have yielded divergent results. In the present study, we examined the function of γδ T cells during sepsis in mice using cecal ligation and puncture (CLP). Mice deficient in γδ T cells had decreased survival times and increased tissue damage after CLP compared with wild-type mice. Furthermore, bacterial load was increased in γδ T cell-deficient mice, yet antibiotic treatment did not change mortality. Additionally, we found that recruitment of neutrophils and myeloid suppressor cells to the site of infection was diminished in γδ T cell-deficient mice. Finally, we found that circulating levels of IFN-γ were increased, and systemic levels of IL-10 were decreased in γδ T cell-deficient mice after CLP compared with wild-type mice. γδ T celldeficient mice also had increased intestinal permeability after CLP compared with wild-type mice. Neutralization of IFN-γ abrogated the increase in intestinal permeability in γδ T cell-deficient mice. The intestines taken from γδ T cell-deficient mice had decreased myeloperoxidase yet had increased tissue damage as compared with wild-type mice. Collectively, our data suggest that γδ T cells modulate the response to sepsis and may be a potential therapeutic target.

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“…This cytokine activates a system for the subsequent production of acute phase proteins and increases C-reactive protein (CRP) 1 . The severities of the immune disorders are proportional to the extent of the surgical trauma [1][2][3] . In addition to the cytokines' actions on wound healing, the mobilization of macrophages is responsible for the production of growth factors, such as vascular endothelial growth factor (VEGF), which are essential for the development of surgical scars and granulation tissue 4,5 .…”

Section: ■ Introductionmentioning

confidence: 99%

A prospective randomized study of the inflammatory responses to multiport and singleport laparoscopic hysterectomies

Tormena

Ribeiro²,

Soares³

et al. 2017

Acta Cir. Bras.

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A prospective randomized study of the inflammatory responses to multiport and singleport laparoscopic hysterectomies 1 AbstractPurpose: To evaluate the inflammatory responses induced by laparoscopic hysterectomies with multiport and singleport approaches.Methods: This was a pilot prospective randomized study that included 42 women candidates for hysterectomy at School of Medicine, Hospital das Clínicas, USP. The patients were randomized to two groups: MP-TLH (total laparoscopic hysterectomy with 3 abdominal incisions), and SP-TLH (total laparoscopic hysterectomy with a single umbilical incision). We evaluated the inflammatory response (via CRP, IL-6, IL-10, TNFα, VEGF and leukogram assessments), surgical time, postoperative pain, blood loss and surgical complications in both groups. Results: Both techniques were similar regarding C-reactive protein (p=.666), IL-6 (p=.833), IL-10 (p=.420), TNF-α(p=.098), VEGF (p=.092) and the leukogram (p=.712) measures. The operative time was significantly longer in the SP-TLH group than in the MP-TLH group (p=.001). The pain evaluation was similar in both groups (p=.170). Hemoglobin variation and the aspirated blood volume were similar in both groups (p=.493 and p=.347). There were no major complications. Conclusions: Multiport and singleport laparoscopic approaches are both safe methods for hysterectomy. Although SP-TLH resulted in a significantly longer operative time than MP-TLH, no differences were observed between the groups in inflammatory responses, blood loss and postoperative pain.

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Systemic Inflammatory Response Syndrome and Nosocomial Infection in Trauma

Abstract: SIRS is predictive of nosocomial infection in trauma through postinjury day 21. Nosocomial infection should be considered as a treatable cause of SIRS in trauma patients, and early diagnostic interventions should be initiated to evaluate for potential causes.

Cited by 80 publications

References 38 publications

Cd4-Expressing Cells Are Early Mediators of the Innate Immune System During Sepsis

Cd4-Expressing Cells Are Early Mediators of the Innate Immune System During Sepsis

γδ T cells mitigate the organ injury and mortality of sepsis

A prospective randomized study of the inflammatory responses to multiport and singleport laparoscopic hysterectomies

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