Date of Graduation

Fall 2022

Degree

Master of Science in Cell and Molecular Biology

Department

Biomedical Sciences

Committee Chair

Patrick J. Brooks

Abstract

Peritonitis is an inflammatory condition affecting the mesothelial cells that line the peritoneal cavity and is commonly induced by bowel perforations. This medical emergency is treated through antibiotic therapy and surgical intervention followed by tissue irrigation (lavage). Acute treatments aim to remove the bacterial burden, however recurring peritoneal infections occur at high rates and contribute to patient morbidity. These recurring infections are likely due to the inability of lavage solutions to remove the entire massive intra-abdominal bacterial load due to intestinal perforation. Numerous antiseptic solutions and antibiotic additives have been evaluated in their ability to improve source control by abdominal lavage, without apparent benefit when compared to sterile saline washout. Saline is a common surgical lavage solution; however, it does not possess antimicrobial properties. Consequently, stabilized hypochlorous acid (HOCl) has been proposed as a safer and more effective irrigation solution with hopes of reducing recurrent infections and improving survival rates. In this study, we compared the efficacy of stabilized HOCl and common irrigation solutions of saline and chlorhexidine gluconate (CHX) on the acute treatment of induced peritonitis. Adult Sprague Dawley rats underwent laparotomy surgeries where peritonitis was induced through cecal ligation and puncture (CLP). Acute peritonitis was treated with resection of damaged tissue and peritoneal irrigation with either stabilized HOCl, saline, or CHX. Treatment efficacy was evaluated through the assessment of gross pathological investigation of peritoneal adhesions, histological analysis of pulmonary tissue, bacterial cultures of peritoneal fluid, analysis of pro-inflammatory TNFα levels, and survival rates. Stabilized HOCl, compared to saline, was found to provide no benefit for improving survival rates and decreasing pulmonary tissue injury; however, survival rates were improved when compared to CHX irrigation. Additionally, stabilized HOCl resulted in higher peritoneal bacterial contamination compared to saline and CHX, 24 hours post-irrigation. Stabilized HOCl also showed no detrimental peritoneal adhesion formation. Across all treatment groups, no serum TNFα was detected, 24 hours post-irrigation. This data suggests that normal saline remains the preferred lavage solution regarding peritonitis source control and further research is warranted to improve peritoneal lavage solutions.

Keywords

peritonitis, sepsis, stabilized hypochlorous acid, chlorhexidine, saline

Subject Categories

Bacteria | Bacterial Infections and Mycoses | Cells | Digestive, Oral, and Skin Physiology | Digestive System | Emergency Medicine | Gastroenterology | Other Chemicals and Drugs | Other Medical Sciences | Surgery | Surgical Procedures, Operative | Tissues | Trauma

Copyright

© Benjamin Michael Pomeroy

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