Didem Baskin, Hüseyin Baskin, Osman Yilmaz, Yasemin Baskin, Necati Gökmen, Canan Tanik
Department of Pediatric Surgery, Sisli Etfal Education and Research Hospital, 34377 Istanbul, Turkey.
J Pediatr Surg. 2008 Aug;43(8):1494-501. doi: 10.1016/j.jpedsurg.2008.01.004.
The aim of this study was to investigate in rats with peritonitis the effect of CO2 insufflation on behavior of bacteria, including antibiotic resistance, and the systemic and regional host response.
Inbred weaned Wistar albino rats were used. Escherichia coli ATCC 25922 was used to induce peritonitis. Rats with peritonitis were allocated to 4 groups: group 1, control; group 2, laparotomy; group 3, laparoscopy; group 4, laparoscopy + laparotomy and were killed at the end of the second hour of peritonitis. Serum, peritoneal fluid, and intraabdominal organs were taken for microbiological (biochemical markers-urease, citrate, indole; virulence factors-biofilm, protease, gelatinase, adherence), systemic immunologic (interleukin 1 [IL-1]alpha, IL-1beta, tumor necrosis factor alpha, IL-6), and regional histopathologic evaluations. Isolated strains were tested against minimum inhibitory concentrations (MICs) and sub-MICs of amikacin and amoxicillin.
Regional inflammatory response was the highest in group 2 but the lowest in group 4. Systemic IL-1alpha level was significantly higher in group 2, and TNF-alpha level was higher in group 3. After the peritonitis process, Escherichia coli began to use citrate and urea in control groups (without antibiotic treatment). In groups 2 and 4, amoxicillin resistance developed.
In peritonitis, in all experimental groups, Escherichia coli used different metabolic pathways other than in normal atmospheric conditions. Amoxicillin resistance developed in open surgery groups. Further kinetic microbiological and immune response studies are needed concerning the early and late effects of CO2 insufflation on various strains of bacteria and mixed infections.
本研究旨在调查在患有腹膜炎的大鼠中，二氧化碳气腹对细菌行为（包括抗生素耐药性）以及全身和局部宿主反应的影响。
使用近交断奶的Wistar白化大鼠。采用大肠埃希菌ATCC 25922诱导腹膜炎。将患有腹膜炎的大鼠分为4组：第1组为对照组；第2组为剖腹手术组；第3组为腹腔镜手术组；第4组为腹腔镜手术+剖腹手术组，并在腹膜炎发作后第2小时末处死。采集血清、腹腔液和腹内器官进行微生物学（生化标志物——脲酶、柠檬酸盐、吲哚；毒力因子——生物膜、蛋白酶、明胶酶、黏附性）、全身免疫学（白细胞介素1 [IL-1]α、IL-1β、肿瘤坏死因子α、IL-6）和局部组织病理学评估。对分离出的菌株进行阿米卡星和阿莫西林的最低抑菌浓度（MIC）及亚MIC测试。
局部炎症反应在第2组中最高，但在第4组中最低。全身IL-1α水平在第2组中显著更高，而TNF-α水平在第3组中更高。在腹膜炎过程后，对照组（未进行抗生素治疗）中的大肠埃希菌开始利用柠檬酸盐和尿素。在第2组和第4组中，出现了阿莫西林耐药性。
在腹膜炎中，在所有实验组中，大肠埃希菌采用了不同于正常大气条件下的不同代谢途径。开放手术组出现了阿莫西林耐药性。需要进一步开展关于二氧化碳气腹对各种细菌菌株和混合感染的早期和晚期影响以及动力学微生物学和免疫反应的研究。
