Effects of age on mortality and antibiotic efficacy in cecal ligation and puncture

• Published in: Shock (Augusta, Ga.) Vol. 19; no. 4; pp. 310 - 313
• Main Authors: TURNBULL, Isaiah R, WIZOREK, Joseph J, OSBORNE, Dale, HOTCHKISS, Richard S, COOPERSMITH, Craia M, BUCHMAN, Timothy G
• Format: Journal Article
• Language: English
• Published: Augusta, GA BioMedical Press 01-04-2003
• Subjects: Age Factors; Aging - physiology; Animals; Biological and medical sciences; Cecum - injuries; Cecum - microbiology; Ceftriaxone - therapeutic use; Disease Susceptibility; Drug Therapy, Combination - therapeutic use; General aspects; Infection pathogenesis; Infectious diseases; Intestinal Perforation - complications; Intestinal Perforation - drug therapy; Intestinal Perforation - microbiology; Ligation; Male; Medical sciences; Metronidazole - therapeutic use; Mice; Mice, Inbred C57BL; Models, Animal; Sepsis - drug therapy; Sepsis - etiology; Tumor Necrosis Factor-alpha - analysis; Wounds, Penetrating - complications; Animal model; Mortality; CLP; Rodentia; Cytokine; C57BU6; Incidence; Blood plasma; Infection; Vertebrata; Antibiotic; Chemotherapy; Mammalia; Treatment; Mouse; Animal; antibiotic efficacy; aging; Antibacterial agent; Age; Comparative study; Quantitative analysis
• ISSN: 1073-2322; 1540-0514
• DOI: 10.1097/00024382-200304000-00003

The incidence and mortality of sepsis increase with age, consequently, 80% of the clinical mortality from sepsis occurs in patients over age 65. Despite this aged clinical population, most research models of sepsis use 6- to 16-week-old mice as patient surrogates. This age range of mice corresponds to human ages 10 to 17 years. To assess the influence of age on rodent CLP and on antibiotic therapy, we studied young (4 month), mature (12 month), and aged (24 month) mice. Male C57BL/6 mice (n = 27-30 in each age group) were subjected to cecal ligation and puncture (CLP), two punctures with a 25-gauge needle. Mice were observed untreated for 10 days. Young mice had 20% mortality, mature mice had 70% mortality (P = 0.0013 vs. young), and aged mice had 75% mortality (P = 0.0001 vs. young). To assess the effects of age on antibiotic therapy, mice were subjected to CLP as above (n = 38-40 in each age group). Mice were then randomized to treatment with intraperitoneal injections of ceftriaxone and metronidazole or normal saline. Therapy was initiated 12 h after CLP, and injections were repeated every 12 h for 7 days. Young mice saw a 56% decrease in mortality from CLP with antibiotic therapy (P = 0.001), and mature mice had a 30% decrease in mortality (P = 0.06). Aged mice saw no benefit from antibiotic therapy. We also compared plasma cytokine levels between young and aged mice after CLP. When compared with young mice, aged mice had higher levels of IL-6 and TNF-alpha 24 h after CLP. However, high IL-6 was predictive of mortality at any age. Mice appear to have age-dependent responses to intra-abdominal sepsis and to appropriate therapy.