B. Lagiewska

Blood cytokine levels rise even after minor surgical trauma.

The exact changes in cytokine production and clinical implications of the increased cytokine levels following operative trauma remain unclear. In this study, systemic production of a spectrum of cytokines, including IL1α, IL1β, IL6, IL8, IL10, and IFNγ, was examined in patients undergoing minor elective operative trauma. The levels of IL1 receptor antagonist (ra) and IL6 soluble receptor (sR) were also determined. Although there were no changes in IL1α and IL1β plasma levels during the entire observation period, there was a significant rise in IL1 ra level in all patients between postoperative day 1 and postoperative day 14. A significant increase in the IL6 plasma level was seen on days 1, 3, and 7 after surgery and an increase in the IL6 sR level was observed on postoperative days 10 and 14. Interestingly, the IL8 plasma values had risen significantly on days 1 and 3 following the operation. In some patients, an elevation in IL10 plasma level was noted on days 1 and 3 postsurgery. Results demonstrated that even a minor surgical procedure such as cholecystectomy with uneventful wound healing was followed by an appearance in the blood circulation of significant levels of cytokines between day 1 and day 14 after surgery. These observations point to the necessity of searching for methods of down-regulating the systemic cytokine effects after surgical trauma for the routine postoperative management.

Bacterial and fungal infections in the early post-transplantation period after liver transplantation: etiologic agents and their susceptibility.

OBJECTIVE It has been reported in many studies that one of the main factors influencing morbidity and mortality in patients receiving transplants is infection after transplantation. PATIENTS AND METHODS The study included 190 adult patients undergoing orthotopic liver transplantation (OLT) between September 2001 and December 2007. All the patients were followed prospectively for infections from the OLT date and during the first 4 weeks after surgery. Immunosuppression consisted of steroids and tacrolimus. Antimicrobial prophylaxis included piperacillin/tazobactam, fluconazole, and selective bowel decontamination (SBD) was performed. Samples of clinical materials were investigated for microbiological cultures. The micro-organisms were cultured and identified in accordance with standard bacteriological procedures. Susceptibility testing was performed using Clinical and Laboratory Standards Institute procedures. RESULTS From 190 OLT recipients, 2213 clinical samples were obtained for microbiological examination. Positive cultures were found in 27.2% (n = 603) of all samples tested; 1252 strains were collected. Gram-positive bacteria were found in 64.1% (n = 802), Gram-negative bacteria were found in 31.6% (n = 396), and fungal strains were isolated in 4.3% (n = 54). Surgical site specimens (n = 1031) were obtained from 190 recipients during the first month after transplantation. Positive cultures accounted for 29.2% (n = 301) of all samples tested. Among the isolated microbial strains (n = 677), most common were Gram-positive bacteria (73.7%; n = 499). Gram-negative bacteria comprised 25.1% (n = 170). There were fungal strains in 1.2% (n = 8). There were 539 urine specimens. Positive cultures accounted for 16.7% (n = 90) of those. Among the isolated microbial strains (n = 210), most common were Gram-negative bacteria (62.4%; n = 131). Gram-positive bacteria comprised 28.6% (n = 60) and fungi 9% (n = 19). There were 549 blood specimens. Positive cultures were found in 30.6% (n = 168) of all samples tested. Among the isolated microbial strains (n = 263), most common were Gram-positive bacteria in 72.3% (n = 190); Gram-negative bacteria were found in 26.2% (n = 69), and fungal strains were isolated in 1.5% (n = 4). There were 69 respiratory tract specimens. Positive cultures were found in 46.4% (n = 32) of all samples tested. Among the isolated microbial strains (n = 84), most common were Gram-positive bacteria (51.2%; n = 43); Gram-negative bacteria comprised 27.4% (n = 23) and fungi 21.4% (n = 18). CONCLUSIONS (1) Surgical site samples were predominated samples after LTx. (2) Our study showed Gram-positive bacteria were 64.1% (n = 802), Gram-negative bacteria, 31.6% (n = 396) and fungal strains isolated in 4.3% (n = 54). (3) The increased proportion of isolates of multi-drug-resistant bacterial strains (methicillin resistant coagulase negative Staphylococcus, vancomycin-resistant Enterococcus, high-level aminoglycoside resistance, and extended- spectrum β-lactamase). (4) These data indicate strict cooperation infection control procedures in these patients.

Detrimental Effect of Aprotinin Ban on Amount of Blood Loss During Liver Transplantation: Single-Center Experience

BACKGROUND Aprotinin, a plasmin inhibitor, had been used for reduction of intraoperative bleeding caused by hyperfibrinolysis during extensive surgery. Prophylaxis with aprotinin to limit blood loss during orthotopic liver transplantation (OLT) had been widely applied until the drug was weaned off the therapeutic list for severe complications. We compared the need for blood and blood products transfusion in patients undergoing OLT with and without the use of aprotinin. MATERIALS AND METHODS A retrospective analysis was performed on 150 patients, who underwent OLT between March 2004 and August 2008 and were divided into 2 groups: the APRO group (n = 111) after induction of anesthesia was given a bolus of 500 kIU of aprotinin in a 30-minutes infusion followed by 140 kIU/h till the end of the OLT in which aprotinin was not administered, and the NON-APRO group (n = 39). RESULTS Patients from the NON-APRO group needed significantly more units of packed red blood cells (PRBC) than the APRO group (5.53 ± 4.89 vs 3.99 ± 3.58 units; P = .037). Avoidance of aprotinin administration (β = 1.408), Child-Pugh score (β = 0.519), and duration of anhepatic phase (β = 0.03) affected the volume of transfused blood according to multiple regression analysis (P < .05). CONCLUSIONS Our study confirmed the important prophylactic role aprotinin used to have during OLT in limiting the need for blood transfusions. Further research and progress in methods of blood loss minimization and monitoring of hemostasis are needed to warrant safe liver transplantation.

CTX-M and TEM as Predominant Types of Extended Spectrum β-Lactamases Among Serratia marcescens Isolated From Solid Organ Recipients

BACKGROUND Serratia marcescens is an important pathogen in hospital infections since organisms resistant to multiple antimicrobials pose a special threat particularly among transplant patients. The aim of this work was to assess the number of strains producing beta-lactamases with extended spectrum (ESBL) among S. marcescens isolated from our patients. MATERIALS AND METHODS We investigated S. marcescens isolated from 2005 to 2008 for ESBL. The phenotype methods were applied and additionally we chose strains for polymerase chain reactions using primers for the most popular types of ESBL. RESULTS Over the investigated time, 257 patients were infected with S. marcescens with 188 (73%) displaying an ESBL-positive phenotype. A Molecular analysis showed that most of them produced both CTX-M and TEM beta-lactamases. In the last year, the percentage of ESBL-producing strains decreased, but also in the last year, we isolated S. marcescens resistant to carbapenems from three patients. CONCLUSIONS The CTX-M type of ESBL predominated among ESBLs produced by strains of S. marcescens. The appearance of strains resistant to carbapenems is alarming.

Resistance to carbapenems among Pseudomonas aeruginosa isolated from patients of transplant wards.

BACKGROUND The aim of the study was to estimate the carbapenems resistance and occurrence of metallo-beta-lactamase (MBL) production among Pseudomonas aeruginosa isolated from patients during the last 2 years. MATERIALS AND METHODS We investigated all P aeruginosa strains derived from Transplantation Institute patients, hospitalized from January 2007 to December 2008. E-tests as well as the three-discs method with imipenem, ceftazidime were used for MBL detection. For the chosen strains, a PCR method was applied for detection of genes determining VIM, IMP, and SMP. RESULTS Among 311 isolated strains from 228 patients only one strain was used for each patient. We showed increased resistance to carbapenems among P aeruginosa in 2008 compared with 2007: from 14% to 22%. About 60% of resistant strains displayed the MBL phenotype. Upon PCR analysis, the VIM-type metallo-beta-lactamase was detected in 70% of them. CONCLUSIONS Despite similar numbers of P aeruginosa-infected patients in 2007 and 2008, the percentage of MBL-producing strains increased from 7% to 15%. Most MBLs belonged to the VIM type.