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CARDIOVASCULAR
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Volume 4, 1999, No 1 |
Immunmodulatory Effects of Perioperative
Antibiotic Therapy in Patients undergoing Cardiopulmonary Bypass
R. Bauernschmitt, R. Lange, H. Mehmanesh, R. Haußmann, C. F.
Vahl, S. Hagl
Objective: Cardiac surgery with cardiopulmonary bypass leads to a whole body inflammatory response characterised by cytokine generation and activation of the complement system. Several antibiotic agents are known to interact with the immune system, so in the following study the influence of two different antibiotics (cefoxitim and imipenem/cilastatin) on the acute phase response to cardiopulmonary bypass was examined.
Patients and methods: 21 male patients undergoing CABG were included and randomized in two groups. Group I (11 patients) received standard antibiotic prophylaxis with cefotaxim, while group II (10 patients) was treated with imipenem/cilastatin. Blood samples were drawn from a central venous line before surgery, 10 min after CPB and 4 hours after CPB. Interleukin-6 (IL-6), Interleukin-8 (IL-8), Tumor Necrosis Factor (TNF) and C3a were determined with commercially available assays.
Results: There were no operative deaths or major complications in either group. Baseline levels of all parameters did not differ between the groups, but treatment with imipenem/cilastatin resulted in significantly lower levels of IL-6, TNF and C3a and a tendency to decreased IL-8-levels.
Conclusion: The perioperative antibiotic management can modify the immune response to CPB. This may be of particular interest in patients undergoing surgery in high-risk conditions in order to attenuate the adverse effects of mediators of the acute phase response.
Key words: cardiopulmonary bypass, inflammatory response, cytokines, complement system, antibiotic therapy
Address for Correspondence:
Robert Bauernschmitt, M.D.
Department of Cardiothoracic Surgery
Deutsches Herzzentrum München
Lazarettstr. 36
D-80636 München
Germany
Reference:
(CVE. 1999; 4 (1): 3-7)
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