Comparison of the efficacy of three different treatments with imipenem versus the classical clindamycin plus tobramycin in experimental peritonitis

Sepsis worsening vascular hyporeactivity of the superior mesenteric artery in portal vein-ligated rats

BACKGROUND

Vascular hyporeactivity is observed in portal hypertensive animals and septic rats. The objective of this study was to investigate whether impairment of superior mesenteric artery vascular contractility in the portal hypertensive rat was further impaired after sepsis.

METHODS

Sepsis was induced by cecum ligation and puncture (CLP) in male portal hypertensive Sprague-Dawley rats that had been subjected to portal vein ligation (PVL) for 14 days. Hemodynamic studies, isolated vascular ring studies, microbiological studies, and plasma nitrite/nitrate measurements were performed 2, 6, and 18 hours after CLP. An additional group of PVL rats received prophylactic imipenem (10 mg intravenously for 1 hour) before CLP and then were studied 6 hours after CLP.

RESULTS

Mean arterial pressure and heart rate of PVL rats were significantly decreased shortly after CLP. CLP caused further nitric oxide production and vascular hyporesponsiveness 6 and 18 hours after CLP compared with the baseline portal hypertensive group. Vascular hyporeactivity was corrected by N-nitro-L-arginine methyl ester + 1400W (1400W is N-(3-(aminomethyl)benzyl)acetamidine hydrochloride, a selective inducible nitric oxide synthase inhibitor). Prophylactic imipenem did not alter nitric oxide production or vascular contractility after sepsis induced by CLP.

CONCLUSION

Our study showed that vascular contractility in portal hypertensive rats is further impaired soon after CLP-induced sepsis.

Animal models of sepsis

Knowledge of sepsis is growing rapidly and new pathogenetic concepts and therapeutic strategies evolve. The animal models of sepsis catalyze this development. Any model of this complex disease is inevitably a compromise between clinical realism and experimental simplification. Against the background of current pathogenetic concepts this review tries to analyze the validity and clinical relevance of each model. Endotoxemia and bacteremia represent models without an infectious focus. They reproduce many characteristics of sepsis and are highly controlled and standardized. However, they reflect a primarily systemic challenge and create neither an infectious focus nor the protracted immune reaction that characterizes sepsis. In this respect, any model with an infectious focus is decisively closer to clinical reality. In these models the peritoneal cavity is contaminated either by bacteria or inoculated feces or perforation of the bowel wall. Both the bolus injection and the implantation of carriers loaded with bacteria or feces are used. In fecal spesis and perforation models the complete spectrum of enteric pathogens is present in the septic focus and infective selection is undisturbed. Here the pathophysiologic and immunologic features of clinical sepsis are successfully reproduced. However, presumably due to inadequate control of the bacterial challenge, only poor interlaboratory standardization is possible. As to optimize models for the clinical reality the choice of an appropriate class of models is crucial. Moreover the incorporation of clinical therapy such as volume resuscitation, antibiotic therapy and surgical treatment of the septic focus is indispensable. Finally, the importance of simulation of comorbidities cannot be overemphasized.

Clinical significance of anaerobic bacteremias in a general hospital. A prospective study from 1988 to 1992

A prospective study was designed to investigate anaerobic bacteremias and evaluate their incidence and significance in a general hospital. One or more blood cultures positive for anaerobic microorganisms were analyzed from each of a total of 61 patients hospitalized between January 1988 and April 1992, in accordance with an established protocol. The clinical repercussions of bacteremia were also analyzed. Two percent of blood cultures were positive for anaerobes, with an incidence of 0.6 cases per 1000 hospitalized patients. The most frequently isolated anaerobes were Bacteroides fragilis and Clostridium perfringens. Intraabdominal disease was the route of entry in 50% of the patients. A death rate of 37.3% was mostly attributed to B. fragilis. Hospitalization in the surgical department, nosocomial acquisition, previous surgery, critical initial clinical status and the presence of complications were significantly associated with increased death rates. No significant differences were found in the clinical course between patients whose antibiotic treatment was judged adequate and those for whom it was considered inadequate. The frequency and incidence of anaerobic bacteremia was low in our hospital. The well-known clinical and epidemiological characteristics of these infections facilitates their prompt diagnosis and empirical treatment with antibiotics of proven effectiveness against anaerobes.