Can one use biologic modifiers to prevent multiple organ dysfunction syndrome after abdominal infections?
Postoperative or trauma-induced intra-abdominal infections can result in sepsis and multiple organ dysfunction syndrome (MODS). Enteric bacteria and endotoxin released from the gut into the peritoneal cavity in response to injury can directly stimulate the inflammatory cascade responsible for the development of systemic inflammation and subsequent MODS. Therapeutic strategies, such as biologic modifiers that are aimed at blocking or enhancing specific mediators of the inflammatory response, have been developed and tested in animal models with varying efficacy in preventing mortality. Specific therapies that have shown beneficial effects in animal models have not proved successful in prospective, randomized human studies, and it is as yet unclear whether cytokine-based therapies will ultimately have a role in preventing MODS. Testing novel therapies in appropriate animal models that closely simulate human intra-abdominal infection is crucial in developing drugs that will be beneficial in preventing sepsis-induced mortality in critically ill patients.
Dellinger
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Division of General Surgery, University of Washington School of Medicine, Seattle, Washington, USA. patch@u.washington.edu
D000005:Abdomen / Q000601:surgery; D000007:Abdominal Injuries / Q000150:complications; D001424:Bacterial Infections / Q000150:complications*; D016207:Cytokines / Q000502:physiology; D042783:Endothelial Cells / Q000502:physiology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D018836:Inflammation Mediators / Q000502:physiology; D007962:Leukocytes / Q000502:physiology; D009102:Multiple Organ Failure / Q000276:immunology / Q000382:microbiology* / Q000517:prevention & control*; D010538:Peritonitis / Q000150:complications* / Q000276:immunology; D011183:Postoperative Complications / Q000517:prevention & control
D016207:Cytokines; D007155:Immunologic Factors; D018836:Inflammation Mediators