scholarly journals Signs of abdominal sepsis in patients with generalized peritonitis

2021 ◽  
Author(s):  
Yu. O. Fuss ◽  
A. O. Voloboyeva ◽  
V. P. Polovyj
Keyword(s):  
Abdominal Sepsis ◽  
Generalized Peritonitis

scholarly journals Dynamics of changes in plasma fatty acid binding proteins and intestinal zonulin in patients with generalized intra-abdominal infection and abdominal sepsis depending on the severity of patients

2021 ◽  
Vol 88 (3-4) ◽  
pp. 46-53
Author(s):  
I. A. Kryvoruchko ◽  
M. O. Sykal
Keyword(s):  
Septic Shock ◽  
Fatty Acid ◽  
Binding Proteins ◽  
Abdominal Sepsis ◽  
Fatty Acid Binding Proteins ◽  
Control Group ◽  
Fatty Acid Binding ◽  
Abdominal Infection ◽  
Generalized Peritonitis ◽  
Intra Abdominal Infection

Objective. Determine the levels of plasma intestinal fatty acid binding proteins levels in combination with zonulin in patients with generalized intra-abdominal infection and abdominal sepsis, and define the clinical usefulness them to assess the severity of patients. Materials ad methods. This study was based on an analysis of 59 patients of both sexes aged 18 to 70 years with generalized intra-abdominal infection (gIAI) and abdominal sepsis (AS). Results. According to the aims and objectives of the study the patients were divided into three groups: the 1st group - 26 patients with generalized peritonitis without sepsis according to the «Sepsis-3» criterion; the 2nd group - 24 patients with sepsis, and the 3rd group - 9 patients with septic shock. We found statistically significant higher levels of I-FABP in the all groups of patients (P = 0.000). The same tendency was observed in all periods of the study, and the most significant levels of I-FABP were by the tenth day after surgery in patients with septic shock: IQR 1567.3- 3876.1 (P = 0.000). Patients with abdominal sepsis did not have a statistically significant change in zonulin levels compared to patients with gIAI without sepsis (P = 0.560) and a similar trend was observed on the 3rd day after surgery (P = 0.135). Only by the 7th and 10th days after surgery changes in zonulin levels were significant in intra-abdominal infection patients without sepsis, with abdominal sepsis and septic shock (P = 0.000 and P = 0.004, respectively). Conclusions. Serum I-FABP levels were valuable and objectively early predictors of the severity of gastrointestinal injuries in gIAI. We also presented evidence of increased plasma zonulin levels in generalized intra-abdominal infection compared with the control group. Elevated zonulin levels were an additional indicator of the observed increase in intestinal permeability during gIAI, but zonulin was not an early biomarker of the severity of gastrointestinal damage like I-FABP.

scholarly journals ROLE OF MONOCYTES IN PATHOGENESIS OF GENERALIZED PERITONITIS

2020 ◽  
pp. 455-460
Author(s):  
A.R. SARAEV ◽  
◽  
SH.K. NAZAROV ◽  
S.G. ALI-ZADE ◽  
◽  
...  
Keyword(s):  
Septic Shock ◽  
Progenitor Cells ◽  
Endothelial Progenitor Cells ◽  
Inflammatory Cytokines ◽  
Abdominal Sepsis ◽  
Endothelial Progenitor ◽  
Generalized Peritonitis ◽  
Tnf Α ◽  
Pro Inflammatory Cytokines

Objective: To study the sepsis markers informativeness to assess the role of monocytes in the pathogenesis of generalized peritonitis (GP). Methods: The study included 160 patients with GP, who were divided into 3 groups, according to the stages of the disease. To establish the activity of monocytes was made a determination of the level of cytokine TNF-α and presepsin in the blood. Results: Studies showed that the level of TNF-α in patient with septic shock was reliably lower (24.5±13.3 pg/ml) than in patients with endogenous intoxication and abdominal sepsis. The value of TNF-α in deceased patients also was low – 4.8±0.9 pg/ml. This indicates a decrease in the ability of monocytes in GP at the stage of septic shock to exude a sufficient amount of pro-inflammatory cytokines in response to endotoxin aggression. The level of presepsin increased by stages and amounted to 355.6±8.6, 783.4±24.0 and 1587.7±70.5 pg/ml, respectively. This indicates the circulation in the blood of the CD14 receptor, which is able to express on monocytes, converting them into endothelial progenitor cells. Conclusions: Monocytes as endothelial progenitor cells contribute to the regeneration and restoration of endothelial function in its dysfunction that develops in GP and abdominal sepsis. In consequence of developing immunosuppression and suppression of monocyte function in the stage of septic shock, the process of renewal of endothelial cells is weakened, the secretion of pro-inflammatory cytokines, in particular TNF-α, decreases, which can contribute to an increase in mortality in septic shock. Keywords: Monocytes, abdominal sepsis, septic shock, endothelial dysfunction, progenitor cells.

scholarly journals Algorithm of the diagnosis and treatment of enteral insufficiency syndrome in peritonitis

2021 ◽  
Vol 180 (2) ◽  
pp. 28-36
Author(s):  
E. A. Korymasov ◽  
S. A. Ivanov ◽  
M. V. Kenarskaya
Keyword(s):  
Treatment Algorithm ◽  
Clinical Signs ◽  
Correct Choice ◽  
Abdominal Sepsis ◽  
Multiple Organ ◽  
Assessment Scale ◽  
Generalized Peritonitis ◽  
Number Of Patients ◽  
Insufficiency Syndrome ◽  
Degree Of Severity

RELEVANCE. The early diagnosis and correction of enteral insufficiency syndrome influence the treatment outcomes in patients with abdominal sepsis and multiple organ failure.The OBJECTIVES was to improve the effectiveness of diagnosis and correction of enteral insufficiency syndrome in patients with generalized peritonitis using the express assessment scale of the severity of enteral insufficiency and the treatment algorithm based on this.MATERIALS AND METHODS. The express assessment scale of the severity of enteral insufficiency syndrome was developed along with the treatment algorithm depending on the detected degree for systematic approach to the management of patients with generalized peritonitis. The study included 39 patients with generalized peritonitis (GP) who had received treatment in the Surgery Department of Samara Regional Clinical Hospital named after V. D. Seredavin in the period of 2019–2020. A computational program was created for quick severity evaluation of enteral insufficiency syndrome and choosing the best treatment strategy.RESULTS. When comparing the severity of enteral insufficiency in patients immediately after the first operation and in 96 hours, a positive dynamics was registered: the number of patients with III degree of severity of enteral insufficiency syndrome decreased from 19 to 4 people, and the number of patients with I degree of severity of enteral insufficiency syndrome changed from 3 to 29 people, this indicated the stabilization of the condition of patients with GP (p<0.05). The statistically significant reduction in the number of points in the limits of each severity was evaluated as the proof of clinical efficacy of the algorithm applied for the enteral insufficiency syndrome correction (p<0.05).CONCLUSION. Due to the correct choice of the treatment algorithm according to the identified severity of enteral insufficiency syndrome, the regression of clinical signs of generalized peritonitis was registered in all patients on the 5th postoperative day (96 hours after surgery).

scholarly journals Surgical Aspects of the Treatment of Patients With Generalized Peritonitis

2021 ◽  
Vol 10 (1) ◽  
pp. 58-65
Author(s):  
B. V. Sigua ◽  
V. P. Zemlyanoy ◽  
S. V. Petrov ◽  
V. A. Ignatenko ◽  
P. A. Kotkov
Keyword(s):  
Statistical Significance ◽  
Abdominal Cavity ◽  
Postoperative Mortality ◽  
Abdominal Sepsis ◽  
Secondary Peritonitis ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Generalized Peritonitis ◽  
Surgical Tactics ◽  
Planned Relaparotomy

BACKGROUND Much attention is currently given to the issues of surgical treatment of common forms of secondary peritonitis, which is associated with unsuccessful results of treatment of this group of patients and the lack of a unified approach to surgical tactics among patients requiring repeated surgical interventions for adequate sanitation of the abdominal cavity.AIM OF STUDY Improvement of the immediate results of treatment of patients with generalized secondary peritonitis by determining the approaches to choosing the optimal surgical tactics.MATERIAl AND METHODS We analyzed the results of treatment of 220 patients with common forms of secondary peritonitis who were treated at the Elizavetinskaya hospital of St. Petersburg in the period from 2013 to 2019. The indicated patients were divided into two groups, comparable in terms of the main features, including the depth pathomorphological changes in the abdominal cavity, assessed by calculating abdominal cavity index (ACI) and the Mannheim peritonitis Index (MPI). The main group consisted of 109 patients, where developed algorithm was used, which supposed planned sanitation relaparotomies within up to 2 days in patients with high values of ACI and MPI. The comparison group included 111 patients who underwent sanitation interventions “on demand”, that is, in the presence of signs of persistence of the infectious process in the abdominal cavity. The results of treatment were compared by assessing the level and structure of postoperative mortality, the frequency of complications, and the length of stay in intensive care units and hospital. Mathematical-statistical dataprocessing, calculations of intensive and extensive coefficients of features, assessment of the statistical significance of differences in features for the studied groups were carried out.RESUlTS The use of a differentiated approach to performing planned relaparotomy in patients with generalized peritonitis made it possible to reduce the overall mortality 1.7-fold (from 51.3 to 30.2%) (p=0.001) due to a decrease in the proportion of abdominal sepsis as a cause of unfavorable the outcome. No significant effect of the use of this algorithm on the frequency and structure of complications, as well as the duration of multiple organ failure, was found.FINDINGS The use of planned relaparotomy among the selected patients helps to reduce postoperative mortality without significantly negatively affecting other treatment results.

scholarly journals Enterococcus faecalis exploits the human fibrinolytic system to drive excess collagenolysis: implications in gut healing and identification of druggable targets

2020 ◽  
Vol 318 (1) ◽  
pp. G1-G9 ◽  
Author(s):  
Richard A. Jacobson ◽  
Kiedo Wienholts ◽  
Ashley J. Williamson ◽  
Sara Gaines ◽  
Sanjiv Hyoju ◽  
...  
Keyword(s):  
Enterococcus Faecalis ◽  
Healing Process ◽  
Abdominal Sepsis ◽  
Infectious Complications ◽  
Fibrinolytic System ◽  
Clinical Safety ◽  
High Concentrations ◽  
Clinically Significant

Perforations, anastomotic leak, and subsequent intra-abdominal sepsis are among the most common and feared complications of invasive interventions in the colon and remaining intestinal tract. During physiological healing, tissue protease activity is finely orchestrated to maintain the strength and integrity of the submucosa collagen layer in the wound. We (Shogan, BD et al. Sci Trans Med 7: 286ra68, 2015.) have previously demonstrated in both mice and humans that the commensal microbe Enterococcus faecalis selectively colonizes wounded colonic tissues and disrupts the healing process by amplifying collagenolytic matrix-metalloprotease activity toward excessive degradation. Here, we demonstrate for the first time, to our knowledge, a novel collagenolytic virulence mechanism by which E. faecalis is able to bind and locally activate the human fibrinolytic protease plasminogen (PLG), a protein present in high concentrations in healing colonic tissue. E. faecalis-mediated PLG activation leads to supraphysiological collagen degradation; in this study, we demonstrate this concept both in vitro and in vivo. This pathoadaptive response can be mitigated with the PLG inhibitor tranexamic acid (TXA) in a fashion that prevents clinically significant complications in validated murine models of both E. faecalis- and Pseudomonas aeruginosa-mediated colonic perforation. TXA has a proven clinical safety record and is Food and Drug Administration approved for topical application in invasive procedures, albeit for the prevention of bleeding rather than infection. As such, the novel pharmacological effect described in this study may be translatable to clinical trials for the prevention of infectious complications in colonic healing. NEW & NOTEWORTHY This paper presents a novel mechanism for virulence in a commensal gut microbe that exploits the human fibrinolytic system and its principle protease, plasminogen. This mechanism is targetable by safe and effective nonantibiotic small molecules for the prevention of infectious complications in the healing gut.

scholarly journals AMPK activates Parkin independent autophagy and improves post sepsis immune defense against secondary bacterial lung infections

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nathaniel B. Bone ◽  
Eugene J. Becker ◽  
Maroof Husain ◽  
Shaoning Jiang ◽  
Anna A. Zmijewska ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Pathogenic Bacteria ◽  
Inflammatory Responses ◽  
Abdominal Sepsis ◽  
Immune Defense ◽  
Bacterial Killing ◽  
Lung Infections ◽  
Sepsis Survivors ◽  
The Impact

AbstractMetabolic and bioenergetic plasticity of immune cells is essential for optimal responses to bacterial infections. AMPK and Parkin ubiquitin ligase are known to regulate mitochondrial quality control mitophagy that prevents unwanted inflammatory responses. However, it is not known if this evolutionarily conserved mechanism has been coopted by the host immune defense to eradicate bacterial pathogens and influence post-sepsis immunosuppression. Parkin, AMPK levels, and the effects of AMPK activators were investigated in human leukocytes from sepsis survivors as well as wild type and Park2−/− murine macrophages. In vivo, the impact of AMPK and Parkin was determined in mice subjected to polymicrobial intra-abdominal sepsis and secondary lung bacterial infections. Mice were treated with metformin during established immunosuppression. We showed that bacteria and mitochondria share mechanisms of autophagic killing/clearance triggered by sentinel events that involve depolarization of mitochondria and recruitment of Parkin in macrophages. Parkin-deficient mice/macrophages fail to form phagolysosomes and kill bacteria. This impairment of host defense is seen in the context of sepsis-induced immunosuppression with decreased levels of Parkin. AMPK activators, including metformin, stimulate Parkin-independent autophagy and bacterial killing in leukocytes from post-shock patients and in lungs of sepsis-immunosuppressed mice. Our results support a dual role of Parkin and AMPK in the clearance of dysfunctional mitochondria and killing of pathogenic bacteria, and explain the immunosuppressive phenotype associated Parkin and AMPK deficiency. AMPK activation appeared to be a crucial therapeutic target for the macrophage immunosuppressive phenotype and to reduce severity of secondary bacterial lung infections and respiratory failure.

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