Concealed progress in the management of severe surgical infection

Article Abstract:

The discovery of antibiotics has had profound effect on medical care, and broad-spectrum antibiotics are now widely used before surgery to prevent infection of the surgical wound. Because organisms emerge that are resistant to antibiotics, the use of these drugs for more than a relatively short period of time after surgery may not be effective. There is little to be gained by developing higher and higher generations of currently known antibiotics. Research should be aimed at obtaining new information about the relationship of the invading organism and its host. Nutrition may play an important role in recovery from surgery, and the route of administration of nutrition may be important. Several factors have hampered improvements in surgical infection rates. These include emphasis on clinically irrelevant animal experiments and esoteric research, rather than research that expands the basic knowledge of the microbe-host relationship. An important area of study is the role of human leukocyte antigens (tissue antigens) expressed on the surface of monocytes (white blood cells) in sepsis (body-wide infection). Human leukocyte antigen may be a valid predictor of surgical sepsis and/or a basic mechanism for the development of sepsis. It is important to remember that many of the agents used may be beneficial at a certain dose and time, but may become harmful if given at a different dose, time, or in another sequence. The practicing surgeon needs instantly useful parameters for host-defense therapy. Clinical trials to determine true clinical usefulness of an agent will be very complex. Surgeons will have to learn to monitor and adjust therapy with these agents. These topics are complex and answers may be long in coming, but they will result in improved patient care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Diseases, Bacterial infections, Etiology (Medicine), editorial

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Association of cytomegalovirus infection with increased morbidity is independent of transfusion

Article Abstract:

Cytomegalovirus (CMV) infection is a viral infection that is strongly influenced by the immune status of the patient. Healthy individuals exposed to this virus experience few symptoms, while immunosuppressed patients develop severe complications such as pneumonia, liver inflammation and pericarditis (inflammation of the sac that surrounds the heart). CMV infection has been associated with blood transfusion, and blood transfusions appear to cause suppression of the immune system. Infections are the most common cause of death in trauma patients. A prospective study was undertaken of 43 severely injured patients to determine the incidence of CMV infection. There were 21 patients found to have active CMV infection; of these, three patients had primary infection and 18 had recurrence of a previous CMV infection. Only three patients were suspected of having CMV infection during their hospitalization; 16 infections occurred within 28 days of hospitalization and five occurred later. Several factors were identified that were significantly associated with CMV infection but were independent of transfusion, including: increased duration of major bacterial sepsis (poisoning of the body by infection) and number of septic episodes; increased duration of anergy (lack of appropriate reaction by the immune system); and longer stay in the intensive care unit and hospital. Mortality was not increased with CMV infection; however, recovery from bacterial infections was delayed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Wounds and injuries, Injuries, Cytomegalovirus infections

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HLA-DR antigen expression on peripheral blood monocytes correlates with surgical infection

Article Abstract:

Development of infection is a serious concern for elderly patients or those who have compromised immune systems. Victims of trauma frequently also have depressed immune systems. In trauma patients both death and infection have been correlated with the ability of certain white blood cells, monocytes, in the peripheral blood (outside the trunk area) to express human leukocyte antigen-DR (HLA-DR). Human leukocyte antigens are molecules expressed on the surfaces of cells that elicit immune responses; HLA antigens are classed according to their location on the cell surface. A study was undertaken of the expression HLA-DR by peripheral blood monocytes in normal volunteers, patients who had undergone elective surgery, and patients who had severe infection. The samples obtained from the volunteers showed minimal variation with regard to age, sex, race, time of day or year, or blood alcohol level. Alcohol was considered a possible variable because of the frequent alcohol abuse seen in trauma patients. It was noted that patients who developed infection after elective surgery had a significantly lower average percent of monocytes expressing HLA-DR than uninfected patients. Nonsurgical patients who developed infection had significantly lower values than did the volunteers. These findings suggested that HLA-DR is a reliable marker of clinical infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Surgical wound infections, HLA histocompatibility antigens, HLA antigens, HLA class II antigens

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