To observe the change in plasma endotoxin and cytokine during the early period of intra-abdominal infection (IAI) complicated by multiple system organ dysfunction (MSOD) in animals. Twenty rabbits were randomly divided in to two groups. One group received the operation of cecal ligation plus puncture (CLP) inducing IAI complicated by MSOD, and another group received sham operation as a control. All animals were placed in metabolic cages and maintained with intravenous infusion for one week. Plasma levels of endotoxin and cytokine (TNF, IL-1, IL-6) were determined seperately at the beginning (0 hour) or 1, 2, 3, 4, 5, 6 and 24 hours after CLP. Blood bacteria cultures and pathological examination of several organs were made when the animal was dead or killed. Results: The levels of plasma endotoxin, TNF and IL-6 were found to be significantly increased at one or two hours after CLP, the incidence rate of bacteriemia was 80% and the pathological alterations in the abdomen and organs were remarkale, with an average survival time of 84.1±39.0 hours in CLP group. No change in plasma IL-1 level was found in the CLP group. Conclusion: The plasma levels of endotoxin and cytokine (TNF and IL-6) do increase in the early period of IAI complicated by MSOD, and the change in plasma IL-1 is not obvious.
Objective To investigate the main characteristics of intro-abdominal microbial infection and the risk factors for it after pancreaticoduodenectomy. Methods Clinical data of 200 patients underwent pancreaticoduodenectomy at the First Affiliated Hospital of Xinjiang Medical University from Sep. 2008 to Sep. 2013 were reviewed retrospectively to investigate the main characteristics of abdominal microbial infection after pancreaticoduodenectomy and risk factors for it. Results Of the 200 patients, cultures of drainage fluids were positive in 78 patients, and 42 of them(21.0%) met the diagnosis of intra-abdominal infection criterion. One hundred and eighty-five pathogenic strains were isolated totally, 64 strains of them(34.6%) were Gram positive cocci, 103 strains(55.7%) were Gram negative bacilli, and 18 strains (9.7%) were fungus. The top 5 kinds of bacteria in order were Staphylococcus aureus(31 strains), Pseudomonas aemginosa(28 strains), Escherichia co1i(22 strains), Klebsiella pneumoniae(18 strains), and Enterococcus faecium (14 strains). Most of the pathogens were resistant to broad-spectrum antibiotics. The resistance rate of Pseudomonas aeruginosa was 60.7%(17/28) to imipenem. Extended spectrum beta lactamases(ESBLs)-producing strains accounted for 22.7%(5/22) and 33.3%(6/18) in Escherichia coli and Klebsiella pneumoniae respectively. The detection rate of methicillin resistant staphylococcus aureus(MRSA) was 45.2%(14/31) in Staphylococcus aureus. Multivariate logistic regression analysis results showed that status of pancreatic fistula and pulmonary infection were the risk factors for intraabdominal infection, patients with high grade of pancreatic fistula(OR=16.252, P=0.003) and with pulmonary infection (OR=2.855, P=0.017) had higher incidence of intra-abdominal infection. Conclusion Gram negative bacilli is the main pathogenic bacteria of abdominal drainage fluids cultivation of microbiology after pancreaticoduodenectomy. Most of them have multi-drug resistance characteristic. Positive prevention and treatment of pancreatic fistula and pulmonary infection can reduce the incidence of intra-abdominal infection.