806 POST TRANSRECTAL PROSTATE BIOPSY SEPSIS: A UNIQUE MODEL TO STUDY THE SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (2010)

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 2010806 POST TRANSRECTAL PROSTATE BIOPSY SEPSIS: A UNIQUE MODEL TO STUDY THE SYSTEMIC INFLAMMATORY RESPONSE SYNDROME Tsung Wen Chong, Kia Joo Puan, and Siew Cheng Wong Tsung Wen ChongTsung Wen Chong More articles by this author , Kia Joo PuanKia Joo Puan More articles by this author , and Siew Cheng WongSiew Cheng Wong More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1482AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Sepsis and the Systemic Inflammatory Response Syndrome (SIRS) are major contributors to urological morbidity and mortality. Much has been published on the role of host immunity in the pathophysiology of SIRS. However, these studies are inevitably based on a heterogenous group of septic patients, and comparisons made with an entirely different cohort of healthy controls. Transrectal ultrasound (TRUS) guided biopsy of the prostate carries a 1-5% risk of gram-negative sepsis following biopsy. These patients are usually healthy prior to biopsy. This unique clinical opportunity allows prospective analysis of patients before and after biopsy, using a systems immunology approach to study the host immune responses to sepsis and SIRS. The objectives are to identify immune markers for predicting the development of SIRS following TRUS biopsy of the prostate. METHODS The study was based on analysis of peripheral blood mononuclear cell components from whole blood of patients before and within 24hrs after TRUS biopsy. If patients developed sepsis, further samples were obtained upon admission and just before discharge. Total white cell counts were performed using a Coulter counter. Phenotypic analyses of the blood monocyte subsets ie. CD16+ and 16- were done using flow cytometry and antibodies staining against a collection of myeloid, activation/ inhibitory markers, antigen presenting molecules and chemokine receptors. The results were stratified according to patients with an uneventful biopsy, or if admitted within 5 days of biopsy with signs of sepsis. RESULTS Within 24hrs after biopsy, CD40 was significantly up-regulated in the CD16+ subset; whilst CX3CR1 was increased on both monocyte subsets. In one patient admitted with SIRS; CD40, CD64, HLA-DR were further increased on both monocyte subsets; however only the CD16+ subset showed further up-regulation of CX3CR1. This patient had a significant febrile response (>39C) in the absence of a positive bacterial blood culture, despite having received a dose of parenteral antibiotics prior to biopsy. CONCLUSIONS The data suggests that there are distinct immunological features in patients who undergo TRUS biopsy and eventually develop SIRS; and that this immune activation may occur even in the absence of a positive bacterial blood culture. This unique clinical model may serve as a useful adjunct to the study of sepsis/ SIRS in general, with broader implications for other forms of gram negative urosepsis. Singapore, Singapore© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e315 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tsung Wen Chong More articles by this author Kia Joo Puan More articles by this author Siew Cheng Wong More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...