Continuous arteriovenous hemofiltration therapy for Staphylococcus aureus-induced septicemia in immature swine.
OBJECTIVE
The goals of this study were: a) to evaluate the efficacy of controlled, continuous arteriovenous hemofiltration in improving morbidity and mortality rates in an immature swine model of Staphylococcus aureus-induced septicemia; b) to determine if ultrafiltrate from septic animals contained mediators that produce pathophysiologic changes observed in untreated S. aureus septic pigs.


METHODS
Prospective, randomized, controlled study with age-matched controls.


METHODS
U.S. Department of Agriculture-licensed biomedical research facility.


METHODS
Sixty-five weaned Poland-China swine (4 to 6 wks of age; 5 to 10 kg).


METHODS
Part 1: Animals received a lethal dose of live S. aureus (8 x 10(9) colony-forming units/kg) over 1 hr. The three treatment groups included: hemofiltration group 1 (eight filtered, eight nonfiltered animals), plasma filtration fraction = 5.5%; hemofiltration group 2 (six filtered, six nonfiltered animals), filtration fraction = 16.6%; and hemofiltration group 3 (six filtered, six nonfiltered animals), filtration fraction = 33.4%. A control, nonseptic group of animals (n = 4) was filtered to obtain "clean" ultrafiltrate (hemofiltration group 4). Part 2: Sterile ultrafiltrate concentrate batches obtained from each group of filtered, septic animals were concentrated and infused into healthy, nonseptic pigs (reinfusion groups 1 through 3).


RESULTS
Physiologic, biochemical, and hematologic variables were measured in all animals every 1 to 3 hrs. Overall length of survival was also recorded. In hemofiltration groups 1 through 3, filtered animals survived significantly longer than matched, nonfiltered (sham-filtered) animals. Increments in survival time increased directly with filtration fraction. Ultrafiltrate concentrate from septic pigs produced death (LD41) and disease similar to those rates observed in untreated S. aureus-septic pigs. Infusion of clean ultrafiltrate concentrate produced no response.


CONCLUSIONS
Continuous arteriovenous hemofiltration significantly improved survival rates in swine with S. aureus-induced sepsis. Resultant ultrafiltrate concentrate contained mediators responsible for some pathophysiologic responses observed in this animal model.
Lee
P A
PA
Humana Advanced Surgical Institutes, Humana Hospital Medical City-Dallas, TX 75230.
Matson
J R
JR
Pryor
R W
RW
Hinshaw
L B
LB
D000367:Age Factors; D000818:Animals; D016470:Bacteremia / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001681:Biological Assay; D001784:Blood Gas Analysis; D001786:Blood Glucose / Q000032:analysis; D004195:Disease Models, Animal; D005260:Female; D006439:Hemodynamics; D006440:Hemofiltration / Q000295:instrumentation / Q000379:methods; D007928:Lethal Dose 50; D008297:Male; D010976:Platelet Count; D011897:Random Allocation; D013203:Staphylococcal Infections / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015996:Survival Rate; D013552:Swine
D001786:Blood Glucose