Changes in the novel orphan, C5a receptor (C5L2), during experimental sepsis and sepsis in humans.

Sepsis is associated with extensive complement activation, compromising innate immune defenses, especially in neutrophils (PMN). Recently, a second C5a receptor (C5L2) was detected on PMN without evidence of intracellular signaling. The current study was designed to determine changes in C5L2 in blood PMN during sepsis. In vitro exposure of PMN to C5a, but not to fMLP, led to reduced content of C5L2. Following cecal ligation and puncture-induced sepsis in rats, PMN demonstrated a time-dependent decrease in C5L2. In vivo blockade of C5a during experimental sepsis resulted in preservation of C5L2. Similarly, PMN from patients with progressive sepsis showed significantly reduced C5L2 expression (n = 26), which was virtually abolished in patients who developed multiorgan failure (n = 10). In contrast, sepsis survivors exhibited retention of C5L2 (n = 12/13). The data suggest that C5L2 on PMN diminishes during sepsis due to systemic generation of C5a, which is associated with a poor prognosis.

Analysis of transmission pathways of Pseudomonas aeruginosa between patients and tap water outlets.

OBJECTIVE: To study the association between infection and faucet contamination in a surgical intensive care unit (SICU). DESIGN: Prospective cohort study. SETTING: One SICU and 12 peripheral wards. PATIENTS: From 45 patients colonized or infected with P. aeruginosa, 87 positive isolates were collected. INTERVENTIONS: P. aeruginosa also was found in 150 of 259 (58%) tap water samples taken from patient rooms. MEASUREMENTS AND MAIN RESULTS: Clonal relationships between patient and tap water isolates were established by random amplification of polymorphic DNA-polymerase chain reaction. A long-time contamination (144 wks) with a single specific genotype for each of the faucets in our SICU was observed. Additional genotypes found in tap water from these faucets were only isolated over short periods of time. P. aeruginosa was shown to reside in single faucets and did not originate from the supplying mains. In 15 of 45 patients (33%), P. aeruginosa genotypes were identical to those from the faucets in the patient rooms. In six other patients, the same genotype was found in faucets from neighboring rooms. Faucets served as the source of infection for patients in 35% of cases, and on the other hand a retrograde contamination of faucets by patients was observed in 15% of cases. CONCLUSIONS: Tap water from faucets contaminated with P. aeruginosa plays an important role in the propagation of this pathogen among patients. A high number of transmissions were shown to occur both from faucet to patient and from patient to faucet. Our SICU served as an epicenter for the spread of P. aeruginosa to peripheral wards. It appears prudent to follow strict hygienic precautions such as wearing gloves and performing thorough alcoholic rub disinfection of hands after patient care and after hand washing at locations known to harbor.

Preoperative oral application of immunoglobulin-enriched colostrum milk and mediator response during abdominal surgery.

Our objective was to evaluate the influence of pre-operative oral application of an immunoglobulin-enriched milk preparation on endotoxin translocation and mediator release during and after abdominal surgery. Forty patients who had been treated by partial (n = 4) or total gastrectomy (n = 8) or pancreatic resection (n = 28) were enrolled in a placebo-controlled pilot study. Pre-operatively, patients were randomly treated for 3 days by oral application of a bovine milk preparation (lactobin 56g/day, n = 20) or placebo (n = 20). In both groups, endotoxin translocation and mediator release was studied pre- and intraoperatively by measuring endotoxin, endotoxin-neutralizing capacity (ENC), interleukin 6, C-reactive protein, transferrin, alpha-2-macroglobulin, albumin, apoliprotein-A1/-B, IgG, IgA, and IgM. The clinical course was followed up by daily evaluation of the Apache-II-score. Clinical data were comparable in both groups. The lactobin group showed significantly lower levels of endotoxin and ENC compared to the placebo group. Acute phase response, endotoxin-binding proteins, and clinical outcome did not differ between both groups. We conclude that prophylactic oral application of lactobin reduces perioperative endotoxemia and prevents reduction of ENC, suggesting a stabilization of gut barrier during abdominal surgery.