Improved survival in severely burned animals using intravenous Corynebacterium parvum vaccine post injury.

This study was designed to determine the potential benefit or toxicity of an immunomodulator, Corynebacterium parvum vaccine, when it is given after severe burn injury. Forty conditioned beagles received a 33% total body surface 3-degree flame burn and were resuscitated with Ringer's lactate solution (3 ml/kg/% burn). Wounds were treated daily for 10 days with silver sulfadiazine cream. Two days and nine days after burn, 21 of the animals received C. parvum vaccine (10 mg/kg IV) in a saline infusion, while 19 control animals were given only saline infusion according to a double-blind protocol. Serial measurements were made of temperature, weight, food intake, hematocrit, hemoglobin, red blood count, white blood count, differential, platelet count, fibrin degradation products, activated partial thromboplastin time, clot retraction, C3, blood cultures, neutrophil function, monocyte function, opsonic index, Na, K, Cl, BUN, glucose creatinine, total protein albumin, albumin/globulin ratio, alkaline phosphatase, SGPT, and SGOT. During 45 days of observation, only 16% of the saline control dogs survived compared to 47% of the treated animals. Total white counts and neutrophil function were the only values which were significantly better in animals receiving C. parvum. However, their correlation with increased survival was marginal This preclinical trial suggests that C. parvum is an effective immunodulator for prevention of fatal infection following burn injury. There were no demonstrable toxic effects of the material in this study.

Transplantation of microbially contaminated cadaver kidneys.

Bacterial cultures of graft perfusion fluid were taken on 514 renal perfusions during a ten-year period. A total of 22 positive cultures were found. Two sets of kidneys were discarded because of the bacteriology report. Only two possible wound infections were found that could be attributable to the preoperative contamination even though 19 of 24 patients with "contaminated" kidneys received no antibiotics. No loss of kidneys or life was found. Of the 22 contaminated perfusates, 18 (80%) originated from other institutions although only 144 (28%) of the total kidneys that were perfused came from other institutions. The majority of cultures indicated that the organisms were skin contaminants or organisms of low virulence. Microbial contamination of perfused cadaver kidneys is uncommon (1.2% in local kidneys and 9.3% in shared kidneys). Contaminated kidneys are not a major source of infection in renal transplant recipients. Kidneys that are contaminated with frequently virulent Gram-negative bacteria, such as Escherichia coli, should be discarded. Contamination of kidneys with Gram-positive organisms should not be a contraindication for transplantation, but the patients should probably be given prophylactic antibiotics.

Bacterial translocation in organ donors: clinical observations and potential risk factors.

Thirty-nine solid-organ donors were evaluated to determine the incidence of bacterial translocation to mesenteric lymph nodes. In addition, clinical variables from 59 local recipients of renal allografts from these donors were examined to assess whether translocation in donors was associated with increased morbidity in the recipients of organs from node-positive donors. Ileocecal lymph node cultures were positive in 18 of 39 donors (46%). Sixteen donors (41%) were hypotensive [systolic blood pressure (SBP) < 90 mmHg] and 27 (69%) received blood product transfusions before organ donation. The presence of hypotension and blood product transfusion were associated with positive and negative cultures, respectively. In 24 (41%) of 59 organs transplanted from donors with periods of hypotension, significantly more (16 of 24, 67%) were associated with positive lymph node cultures than with negative cultures (8 of 24, 33%; p = 0.029). In recipients of organs from node-positive versus node-negative donors there was a trend toward higher incidence of infection (32% vs. 25%), need for hemodialysis post-transplant (29% vs. 23%), graft loss within 1 yr (24% vs. 19%), and lack of blood transfusion prior to organ procurement (43% vs. 23%), although these variables were not significantly different between the groups. Hypotension or inadequate resuscitation may contribute to increased bacterial translocation to mesenteric lymph nodes. The overall impact upon the recipients of organs from donors with demonstrable translocation to lymph nodes remains undefined.