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Title: Characterisation of innate immunity in patients with ventilator-associated pneumonia
Author: Kefala, K.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2009
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Ventilator-associated pneumonia (VAP) is the most common ICU-acquired infection in patients receiving mechanical ventilation, associated with excess mortality, morbidity and cost. The hypothesis of this work was that an exaggerated pro-inflammatory response is present in patients with VAP while the local antiprotease/antimicrobial expression is impaired, potentially facilitating neutrophil-mediated tissue injury. In the same context, neutrophils in patients with VAP may have impaired capacity to eliminate pathogens whilst having the potential to cause tissue damage. Healthy volunteers from primary care and patients from a general ICU with clinically suspected VAP were recruited in the study. Bronchoscopy and broncoalveolar lavage (BAL) was performed and in the patients the presence or absence of pathogens at a concentration ≥104 cfu/ml of BAL fluid (BALF) defined the VAP group and the NON-VAP group respectively. BALF from patients with VAP displayed a greater number of neutrophils and this neutrophil influx was associated with a florid pro-inflammatory response as demonstrated by significantly elevated interleukin-8 (IL-8) and interleukin-1ß (IL-1ß) levels. Circulating neutrophils from both groups of critically ill patients exhibited significantly impaired phagocytic capacity and appeared to have the potential, upon contact with bacterial products, to cause damage to the membrane of epithelial cells. BALF SLPI levels were lower while elafin levels were elevated in the BALF of both groups of critically ill patients. However BALF inhibition of neutrophil elastase was impaired suggestive perhaps of deactivation or down-regulation of antiprotease expression.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available