Background
Prevention of intraabdominal abscess formation constitutes an important goal in treatment
of secondary peritonitis. Fibrinolytic therapy may be effective in this respect. The
efficacy of recombinant tissue plasminogen activator (rtPA) and urokinase is compared
in a preclinical model for surgical treatment of peritonitis.
Methods
Peritonitis was induced by intraperitoneal bacterial challenge in male Wistar rats.
After 1 hour, surgery was performed. Four groups (n = 20) were treated with one of
the following: rtPA, urokinase, streptokinase (a negative protein control), or saline.
Blood cultures were taken at 6 and 24 hours; cell counts and cytokine measurements
were performed in peritoneal fluid at 1, 3 and 5 days. After 5 days, animals were
killed and intraperitoneal abscess formation was analyzed.
Results
Both rtPA and urokinase strongly (> 75%) and significantly (P < .05) reduced abscess
formation without negative side effects. No bleeding complications were observed.
Fibrinolytic therapy altered the intraperitoneal cellular distribution (less neutrophils
and more macrophages) but did not essentially alter the courses of interleukin-6 and
interleukin-10 (decreasing in time) or tumor necrosis factor-α (increasing in time)
levels.
Conclusion
Both rtPA and urokinase effectively and safely reduce abscess formation in a rat model
for treatment of secondary peritonitis. Fibrinolytic therapy should be further developed
for clinical application.
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Article info
Publication history
Published online: May 22, 2008
Accepted:
March 31,
2008
Footnotes
Presented at the Joint Annual Meeting of the Surgical Infection Society Europe and North America, Miami, Florida, May 3–5, 2005.
Supported in part by research grants from the Radboud University Nijmegen Medical Centre.
Identification
Copyright
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
