Effect of anti-OprF-OprI immunoglobulin on APACHE II score in a porcine two-hit model of hemorrhagic shock/resuscitation and pseudomonas aeruginosa sepsis.
Up to now, randomized clinical trials of treatment of bacterial sepsis with immunoglobulins show conflicting results. This paper investigates the effect of prophylactic immunization with anti-OprF-OprI antiserum on the APACHE II score in a clinically relevant two-hit model of hemorrhagic shock/resuscitation followed by Pseudomonas aeruginosa sepsis in pigs.



Twenty-three German Landrace-Hybrid pigs underwent chronic implantation of vascular catheters (internal and external jugular vein, carotic and pulmonary artery), hemorrhagic shock (mean blood loss 40% of estimated blood volume) for 45 min, followed by resuscitation with crystalloid, colloid, and shed blood. Randomization was to a control group (no immunization, n=6), an F-I group (50 mg/kg i.p. anti-OprF-OprI immunoglobulin, n=6), an S group (50 mg/kg i.p. unspecific porcine immunoglobulins, n=6), and a PS group (50 mg/kg i.p. immunoglobulin against the antigens of heat-killed P. aeruginosa, n=5). After at least 18 h for recovery from anesthesia, the pigs underwent a continuous intravenous infusion of P. aeruginosa for 48 h. Thereafter, the animals were monitored for another 48 h and then dissected.



The APACHE II score significantly increased from baseline value in all groups during bacterial challenge. However, there were no between-group differences in APACHE II score. In contrast, pigs of the F-I and PS groups showed significant lower lung concentrations of P. aeruginosa (p<0.05 vs. control group) at autopsy.



These experimental data suggest that under comparable clinical conditions, a prophylactic immunization with anti-OprF-OprI immunoglobulin would not have an overall benefit to patients with P. aeruginosa sepsis.
Haberstroh
J
J
Abteilung Allgemein- und Viszeralchirurgie, Chirurgische Forschung, Chirurgische Universitatsklinik, Freiburg, Germany.
Gilleland
H E
HE
von Specht
B-U
BU
D018806:APACHE; D000818:Animals; D000907:Antibodies, Bacterial / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000276:immunology*; D002678:Chimera; D004195:Disease Models, Animal; D007116:Immunization, Passive; D008074:Lipoproteins / Q000276:immunology*; D018272:Porins / Q000276:immunology*; D011552:Pseudomonas Infections / Q000276:immunology / Q000628:therapy*; D011550:Pseudomonas aeruginosa / Q000276:immunology; D012151:Resuscitation; D018805:Sepsis / Q000276:immunology / Q000628:therapy*; D012771:Shock, Hemorrhagic / Q000276:immunology / Q000628:therapy*; D013552:Swine
D000907:Antibodies, Bacterial; D001426:Bacterial Proteins; D008074:Lipoproteins; D018272:Porins; C060507:outer membrane lipoprotein I, Bacteria