Local serum application: restoration of sufficient host defense in human peritonitis

Abstract

Intra-abdominal host defense in human peritonitis is hampered by a severe dysfunction of phagocytosis due to an almost complete breakdown of bacteria opsonization. This defect relates to some opsonin consumption, but mainly to proteolytic and oxidative opsonin destruction. To restore and protect intact opsonins we have developed a clinical approach of intra-operative peritoneal serum application. In a prospective, controlled, and randomized study of 30 patients with generalized peritonitis we have investigated the impact of this adjuvant therapy on biochemical parameters and clinical features. Serum application induced a rise in opsonin concentration and, even more pronounced, opsonin function (P < 0.01) of several hours' duration, leading to a distinct improvement of bacteria elimination. In addition, alpha 1-proteinase inhibitor (alpha 1-P)I levels were significantly increased after 1 h (P < 0.05) in the treatment group. The follow-up by APACHE II scoring indicated an improvement in the therapy group over the whole observation period of 14 days. Lethality in the therapy group was 33% compared to 53% in controls. These results indicate that the intra-operative restoration of physiologic intra-abdominal milieu can improve bacteria opsonization and elimination, thus contributing to a favourable clinical course in abdominal sepsis.