Is the limulus amebocyte lysate the sole predictor of septic episodes in major thermal injuries?

Citation
Jp. Heggers et al., Is the limulus amebocyte lysate the sole predictor of septic episodes in major thermal injuries?, J BURN CARE, 19(6), 1998, pp. 512-515
Citations number
11
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Surgery
Journal title
JOURNAL OF BURN CARE & REHABILITATION
ISSN journal
0273-8481 → ACNP
Volume
19
Issue
6
Year of publication
1998
Pages
512 - 515
Database
ISI
SICI code
0273-8481(199811/12)19:6<512:ITLALT>2.0.ZU;2-V
Abstract
Septic episodes in thermal injuries are usually hallmarked by a series of p hysiologic parameters that include tachypnea, prolonged paralytic ileus, hy perthermia or hypothermia, altered mental status, thrombocytopenia, leukocy tosis or unexplained leukopenia, acidosis, and hyperglycemia. Recent studie s with polycystic kidney disease have clearly indicated that the Limulus am ebocyte lysate (LAL) assays were predictive of fungal infections in this pa tient population. Because both bacteria and fungi produce lipopolysaccharid e that can be identified with the LAL assay, we randomly assayed sequential sera of 45 patients with major thermal injuries for positivity in the LAI, assay, with use of the QCL-1000 kit (BioWhittaker, Walkersville, Md). The average burn size of this patient population was 63.43% total body surface area. The average age of the patient was 6.2 years. The sex distribution in cluded 30 males and 15 females. The infectious agents included gram-positiv e cocci and gramnegative rods, and 14 patients had concomitant fungal infec tions. Eighty-five percent of the patients tested were positive for endotox in, with levels ranging from < 0.1 EU/mL to > 1.0 EU/mL. The predominant or ganism isolated before or on the date the serum was drawn was Pseudomonas a eruginosa (51%), followed by Klebsiella pneumoniae (15%). The remaining 34% were a variety of Enterobacteriaceae. Of the 14 patients who yielded a fun gus, 3 had negative LAL assays. Two patients with an elevated LAL grew only Staphylococcus epidermidis in the bloodstream and the wounds. These data c learly indicate that the LAL assay cannot be relied on as the sole predicto r of septic episodes; however, it can be, an adjunctive test to confirm sep sis when the other parameters have been considered.