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Available online http://ccforum.com/supplements/13/S4
Critical Care Volume 13 Suppl 4, 2009Sepsis 2009Amsterdam, the
Netherlands, 11–14 November 2009
Published online: 11 November 2009These abstracts are available
online at http://ccforum.com/supplements/13/S4© 2009 BioMed Central
Ltd
P1Urokinase receptor is necessary for bacterial defenseagainst
Gram-negative sepsis (melioidosis) by facilitatingphagoctytosis
W Joost Wiersinga1,2, JWR Hovius1,2, GJW van der Windt1,2, JCM
Meijers3, JJ Roelofs4, A Dondorp5, M Levi1, NP Day5,6, SJ
Peacock5,6, T van der Poll1,21Center for Infection and Immunity
Amsterdam, 2Center forExperimental and Molecular Medicine,
3Department of VascularMedicine and 4Department of Pathology,
Academic MedicalCenter, University of Amsterdam, Amsterdam, the
Netherlands;5Mahidol-Oxford Tropical Medicine Research Unit,
Faculty ofTropical Medicine, Mahidol University, Bangkok, Thailand;
6Centerfor Clinical Vaccinology and Tropical Medicine, Nuffield
Departmentof Clinical Medicine, University of Oxford, UKCritical
Care 2009, 13(Suppl 4):P1 (doi: 10.1186/cc8057)
Introduction Urokinase receptor (uPAR, CD87), a
glycosylphos-phatidylinositol-anchored protein, is considered to
play animportant role in inflammation and fibrinolysis. The
Gram-negativebacterium Burkholderia pseudomallei is able to survive
andreplicate within leukocytes and causes melioidosis, an
importantcause of pneumonia-derived community-acquired sepsis in
South-east Asia. We here investigated the expression and function
ofuPAR both in patients with septic melioidosis and in a
murinemodel of experimental melioidosis.Methods Using a
translational approach we conducted a patientstudy in patients with
culture-confirmed sepsis caused byB. pseudomallei, in vitro
experiments using wild-type (WT) anduPAR knockout (KO) cells, and
mouse studies using WT anduPAR KO mice inoculated with B.
pseudomallei.Results uPAR mRNA and surface expression was increased
inpatients with septic melioidosis in/on both peripheral
bloodmonocytes and granulocytes as well as in the
pulmonarycompartment during experimental pneumonia-derived
melioidosisin mice. uPAR-deficient mice intranasally infected
withB. pseudomallei showed an enhanced growth and disseminationof
B. pseudomallei when compared with WT mice, correspondingwith
increased pulmonary and hepatic inflammation. uPAR KOmice
demonstrated significantly reduced neutrophil migrationtowards the
pulmonary compartment after inoculation withB. pseudomallei.
Further in vitro experiments showed that uPAR-deficient macrophages
and granulocytes display a markedlyimpaired phagocytosis of B.
pseudomallei. Additional studiesshowed that uPAR deficiency did not
influence hemostatic andfibrinolytic responses during severe
melioidosis.Conclusions These data suggest that uPAR is crucially
involved inthe host defense against sepsis caused by B.
pseudomallei byfacilitating the migration of neutrophils towards
the primary site ofinfection and subsequently facilitating the
phagocytosis ofB. pseudomallei.
P2A comparison of acute lung inflammation in
Klebsiellapneumoniae B5055-induced pneumonia and sepsis inBALB/c
mice
V Kumar, S ChibberDepartment of Microbiology, Panjab University,
Chandigarh, IndiaCritical Care 2009, 13(Suppl 4):P2 (doi:
10.1186/cc8058)
Introduction Lungs play an important role in the body’s
defenseagainst a variety of pathogens, but this network of immune
systemmediated defense can be deregulated during acute
pulmonaryinfections.Objective The present study compares the acute
lung inflam-mation (ALI) occurring during Klebsiella pneumoniae
B5055-induced pneumonia and sepsis in BALB/c mice.Methods Pneumonia
was induced by intranasal instillation ofbacteria (104 CFU) while
sepsis was developed by placing thefibrin–thrombin clot containing
a known amount of bacteria(102 CFU) into the peritoneal cavity of
animals. Various cytokine(TNFα and IL-1α) levels were estimated
using ELISA and thedegree of lung inflammation (that is,
inflammatory cell infiltration)was evaluated by histopathological
analysis. The other markers ofinflammation (that is, nitric oxide
(NO), malondialdehyde (MDA)and myeloperoxidase (MPO)) were
estimated by standardbiochemical methods.Results Mice with sepsis
showed 100% mortality within 5 postinfection days whereas all the
animals with pneumonia survived. Inanimals suffering from K.
pneumoniae B5055-induced pneumoniaall the inflammatory parameters
(TNFα, IL-1α, MPO, MDA and NO)were found to be maximum until the
third post infection day, afterthat a decline was observed, whereas
in septic animals all theabove-mentioned markers of inflammation
kept on increasing untildeath of the animals. Histopathological
study showed thatinflammatory damage to the lungs in pneumonia was
not verysevere as lesser neutrophil infiltration and pulmonary
damage (thatis, alveolitis, bronchiolitis, endothelitis and
perivascular congestion)was seen as compared with lungs taken from
septic animals. Thiscan be further strengthened by the presence of
alternativelyactivated alveolar macrophages (AAMacs) or foam cells
in lungs ofmice with pneumonia after the third post infection day
and theirnumber kept on increasing until the seventh post infection
day,which might have contributed to the induction of resolution
ofinflammation and clearance of the infection. But no such AAMacsor
foam cells were seen in lungs of septic mice on histo-pathological
examination, lungs were seen to be infiltrated withonly neutrophils
on all experimental days.Conclusions Hence, during pneumonia
controlled activation ofAAMacs or foam cells led to the resolution
of inflammation andinfection as well.
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P7Faster differentiation of Staphylococcus aureus
versuscoagulase-negative Staphylococci from blood culturematerial:
a comparison of different bacterial DNA isolationmethods
AJM Loonen1, WLJ Hansen1, A Jansz2, H Kreeftenberg2, CA
Bruggeman1, PFG Wolffs1, AJC van den Brule31Department of Medical
Microbiology, Maastricht University MedicalCenter, Maastricht, the
Netherlands; 2Department of Intensive Care,Catharina Hospital,
Eindhoven, the Netherlands; 3Department ofMolecular Diagnostics,
Catharina Hospital, Eindhoven, the NetherlandsCritical Care 2009,
13(Suppl 4):P7 (doi: 10.1186/cc8063)
Introduction Frequent usage of medical devices, such
asintravenous lines, often results in sepsis, which is
characterized byhigh morbidity and mortality. Rapid and reliable
detection anddifferentiation between Staphylococcus aureus and
coagulase-negative Staphylococci (CNS) is therefore clinically
relevant to beable to provide adequate early treatment. Blood
culture is still thegold standard method in identifying these
pathogens but is timeconsuming. Molecular diagnostics might be a
promising alternativeto reduce this time-to-result delay.Objective
This study aims to compare different DNA extractionmethods from two
commonly used blood culture materials, BACTEC(BD) and Bact/ALERT
(Biomerieux), to accelerate differentiationbetween S. aureus and
CNS.Methods Two fast real-time PCR duplex test assays, targeting
theTuf gene, to differentiate S. aureus from CNS, were developed
inorder to select the most sensitive one. This Tuf RT-PCR was
usedto compare three different DNA isolation methods on two
differentblood culture systems. Negative blood culture material was
spikedwith S. aureus; bacterial DNA was isolated with:
automatedextractor EasyMAG (Biomerieux), automated extractor
MagNAPure (Roche), and a manual kit MolYsis Plus (MolZyme).Results
The best Tuf RT-PCR method appeared to have asensitivity of 100
CFU/ml. Approximately 50 positive blood culturescontaining
Gram-positive cocci in clusters were tested in the TufRT-PCR and
all were identified correctly. Bacterial DNA isolation,from spiked
blood culture material, with the EasyMAG showed thehighest
analytical performance with a detection limit of 103 CFU/mlin
Bact/ALERT material, whereas using BACTEC resulted in adetection
limit of 104 CFU/ml. Hand-on time, for 26 samples, waslowest for
the EasyMAG (10 minutes) and highest for the manual kitof MolZyme
(2 hours). Total handling time was highest for theMolYsis Plus kit
(3.5 hours) and lowest for the automated extractorEasyMAG (50
minutes).Conclusions A sensitive RT-PCR was developed for detection
anddifferentiation of S. aureus versus CNS. Bacterial DNA
isolationfrom Bact/ALERT blood culture material seems to show
betterreproducibility compared with isolation from BACTEC
bloodculture material. In this preliminary study the EasyMAG
performedbetter when compared with MolYsis Plus and the MagNA
Puresystem. In future work this method will be further evaluated
withreduced culture times.
P8Effect of canine hyperimmune plasma on TNFαα andinflammatory
cell levels in a lipopolysaccharide-mediatedrat air pouch model of
inflammation
B Essien, M Kotiw, H Buttler, D StruninCentre for Systems
Biology, University of Southern Queensland,Toowoomba, Queensland,
AustraliaCritical Care 2009, 13(Suppl 4):P8 (doi:
10.1186/cc8064)
Introduction Unregulated elevated levels of serum TNFα havebeen
associated with proinflammatory cytokine cascades that
arecharacteristic in diseases such as septic shock. Endotoxic
shock,which has a poorer prognosis than found with other forms of
septicshock, is mediated by lipopolysaccharide (LPS), a molecule
that isreleased from the outer membrane of Gram-negative bacteria.
LPSis a potent stimulator of TNFα secretion by serum monocytes
andtissue macrophages. Whilst the use of monotherapeutic
TNFαantagonists has been trialed, none have been registered for use
inpatients with sepsis.Objective The purpose of this study was to
test the effect ofcanine hyperimmune frozen plasma (HFP), which is
known tocontain elevated levels of soluble TNFα receptor 1
(sTNFR1), onTNFα and inflammatory cell levels in a LPS-mediated rat
air pouchmodel of inflammation.Methods A dorsal air pouch in 175 to
200 g Sprague–Dawley ratswas formed by 20 ml subcutaneous infusions
of sterile air.Prophylactic subcutaneous injections of canine HFP,
canine freshfrozen plasma (FFP) or carprofen were administered
daily for3 days into the lateral flank of the right foreleg at
doses recom-mended by the manufacturers (n = 10 for each treatment
group).Pouch fluid was harvested by syringe at 1, 6, 12, 24 and 48
hourspost LPS administration and subjected to histological
andcytokine/cytokine receptor analysis. TNFα and sTNFR1 levels
weredetermined by ELISA and an immunofluorescent dot blot
assay.Results Pouch fluid analysis: maximal effects were detected
at6 hours post LPS administration. TNFα levels were
significantlydepressed in animals dosed with HFP, but not in
animals treatedwith FFP or carprofen (P /GrayImageDict >
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