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Annals of Intensive Care

, 6:41

First Online: 29 April 2016Received: 27 December 2015Accepted: 11 April 2016

Abstract

BackgroundEarly detection of infection is critical to rapidly starting effective treatment. Diagnosis can be difficult, particularly in the intensive care unit ICU population. Because the presence of polymorphonuclear neutrophils in tissues is the hallmark of inflammatory processes, the objective of this proof of concept study was to determine whether the measurement of reactive oxygen species ROS could be an efficient diagnostic tool to rapidly diagnose infections in peritoneal, pleural and bronchoalveolar lavage BAL fluids in ICU patients.

MethodsWe prospectively included all patients hospitalized in the 21-bed surgical ICU of a teaching hospital from June 2010 to February 2014 who presented with systemic inflammatory response syndrome with suspicion of a peritoneal or pleural fluid or pulmonary infection needing a BAL. Instantaneous basal ROS production was measured in fluids and after phorbol 12-myristate 13-acetate PMA stimulation. We compared patients with infected fluids to those with non-infected fluids.

ResultsThe overall ICU mortality rate was 34 %. A majority of patients were sampled following a delay of 5 days 2–12 after ICU admission, with most receiving antibiotics at the time of fluid sampling 71 %. Fluids were infected in 21-65 samples: 6-17 peritoneal fluids, 8-28 pleural fluids and 7-20 BALs. ROS production was significantly higher in the infected than in the non-infected group at baseline and after PMA stimulation in the peritoneal and pleural fluids but not in BAL.

ConclusionAssessing instantaneous ROS production appears as a fast and reliable diagnostic method for detecting peritoneal and pleural fluid infection.

KeywordsPolymorphonuclear neutrophils Inflammation Infection Critical care Diagnosis Bronchoalveolar lavage Ascites Pleural effusion Reactive oxygen species AbbreviationsBALbronchoalveolar lavage

CFUcolony-forming units

DAMPsdamage-associated molecular patterns

HBSSHanks’ balanced salt solution

HVhealthy volunteers

ICUintensive care unit

PMAphorbol 12-myristate 13-acetate

PMNspolymorphonuclear neutrophils

ROSreactive oxygen species

SAPS IISimplified Acute Physiology Score

SIRSSystemic inflammatory response syndrome

SOFASequential Organ Failure Assessment Score

Jean Bardon and Anne-Claire Lukaszewicz contributed equally to this work

Electronic supplementary materialThe online version of this article doi:10.1186-s13613-016-0142-8 contains supplementary material, which is available to authorized users.

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Autor: Jean Bardon - Anne-Claire Lukaszewicz - Valérie Faivre - Benjamin Huot - Didier Payen

Fuente: https://link.springer.com/







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