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The effect of fibrin glue on intraperitoneal contamination in rats treated with systemic antibiotics
R J Schwartz1, T J Dubrow, R A Rival
1Department of Surgery, Harbor-UCLA Medical Center, Torrance 90509.
Abstract:
Intraperitoneal fibrin sealant lowers septic mortality in a rat model of peritoneal contamination (2 x 10(6) organism inoculum) at the cost of increased late intraabdominal abscesses. This study utilized parenteral antimicrobials to determine if the protective effect of intraperitoneal fibrin could be achieved without increasing the late abscess formation rate. One hundred and fifty-five rats were divided into four groups. Gelatin capsules containing various dilutions of feces (10(10) CFU/ml) and barium sulfate were placed into the abdomen in all groups. Group I controls had no antibiotics or fibrin. In group II, the capsule was surrounded by a solution of cryoprecipitate, thrombin, and calcium (fibrin "glue"). Groups III (no fibrin, antibiotics) and IV (fibrin, antibiotics) received a broad-spectrum cephalosporin intramuscularly postoperatively and then daily. Surviving rats were sacrificed on the tenth postoperative day. At a moderate volume of fecal inoculum (0.3 ml), fibrin reduced mortality from 100% in the control group to 0% in treated animals (P less than 0.001) that did not receive antibiotics. Abscesses formed in 10% of the surviving fibrin-treated rats which were implanted with 0.1 ml of inoculum. In the 0.2 and 0.3 ml inoculum groups substantially more abscesses occurred (75 and 70%, respectively). The protective effect of fibrin was not manifested in the antibiotic-treated rats since no deaths occurred in either group. At higher and lower inoculum doses, no significant differences between fibrin and control groups were observed in mortality or abscess formation, whether or not antibiotics were given.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Intraperitoneal fibrin sealant significantly reduced septic mortality in rats with peritoneal contamination. However, this benefit came with an increased rate of late intraabdominal abscesses, particularly with higher fecal inoculums.
Area of Science:
- Surgical Innovation
- Infectious Disease Research
- Animal Models
Background:
- Peritoneal contamination poses a significant risk of sepsis and mortality.
- Fibrin sealants have shown promise in reducing septic mortality but may increase late abscess formation.
- The role of parenteral antimicrobials in conjunction with fibrin sealants for peritonitis is not fully understood.
Purpose of the Study:
- To evaluate the efficacy of intraperitoneal fibrin sealant in reducing septic mortality in a rat model of peritoneal contamination.
- To determine if combining fibrin sealant with parenteral antimicrobials can mitigate the increased risk of late intraabdominal abscesses.
- To assess the impact of varying fecal inoculum volumes on mortality and abscess formation when using fibrin sealant and/or antibiotics.
Main Methods:
- A rat model of peritonitis was established using gelatin capsules containing fecal material and barium sulfate.
- Four groups were studied: control (no treatment), fibrin sealant only, antibiotics only, and fibrin sealant with antibiotics.
- Mortality and intraabdominal abscess formation were assessed in surviving rats on postoperative day 10.
Main Results:
- Fibrin sealant alone significantly reduced mortality (100% to 0%) at a moderate fecal inoculum (0.3 ml) (P < 0.001).
- Increased abscess rates were observed in fibrin-treated groups, especially with higher inoculum volumes (75-70% for 0.2-0.3 ml).
- The protective effect of fibrin was masked in antibiotic-treated groups due to zero mortality in both antibiotic groups.
Conclusions:
- Intraperitoneal fibrin sealant is effective in reducing mortality from peritoneal contamination in rats.
- The use of fibrin sealant is associated with a higher incidence of late intraabdominal abscesses.
- Further research is needed to optimize the use of fibrin sealants in conjunction with antibiotics to balance mortality reduction and abscess prevention.