Insulin increases resistance to burn wound infection-associated sepsis.
OBJECTIVE
This study was designed to determine the ability of insulin to improve outcome following a Pseudomonas aeruginosa wound infection in a rodent model of severe burn injury.


BACKGROUND
Severe burn injury predisposes patients to burn wound infections that can disseminate, lead to uncontrolled inflammation, and induce septic shock. Whereas insulin administration has been extensively discussed to improve morbidity and mortality in critically ill patients, the ability of insulin to improve outcomes of severely burned patients with infected burn wounds is not known.


METHODS
Sprague-Dawley rats.


METHODS
University setting.


METHODS
Burn-injured Sprague Dawley rats were randomized into treatment groups that received either saline or insulin. Burn wounds were topically inoculated with a lethal dose of Pseudomonas aeruginosa 6 days after injury.


RESULTS
Survival, systemic dissemination of bacteria, systemic inflammation, and immune activation were examined. Insulin decreased the early inflammatory response to a severe burn injury. Treatment with low doses of insulin following burn injury improved the outcome of rats in response to a lethal burn wound infection. Specifically, survival was improved and systemic dissemination of bacteria from the wound was decreased. Systemic inflammation, indicated by serum interleukin-6 levels, was significantly decreased by insulin treatments after injury. Additionally, insulin treatments were associated with alterations in B and T lymphocyte responses to wound infection.


CONCLUSIONS
Although the mechanisms by which insulin improves outcome following a lethal burn wound infection are not known, the data suggest that immunologic responses to infection may be altered by postburn insulin treatments.
Gauglitz
Gerd G
GG
Shriners Hospitals for Children, University of Texas Medical Branch, Galveston, Texas, USA.
Toliver-Kinsky
Tracy E
TE
Williams
Felicia N
FN
Song
Juquan
J
Cui
Weihua
W
Herndon
David N
DN
Jeschke
Marc G
MG
D000818:Animals; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D002056:Burns / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005434:Flow Cytometry; D007249:Inflammation / Q000517:prevention & control; D007328:Insulin / Q000494:pharmacology*; D008213:Lymphocyte Activation / Q000187:drug effects; D015999:Multivariate Analysis; D011336:Probability; D011552:Pseudomonas Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D012307:Risk Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014945:Wound Healing / Q000187:drug effects / Q000502:physiology; D014946:Wound Infection / Q000150:complications / Q000188:drug therapy* / Q000401:mortality
D007328:Insulin