ENHANCEMENT OF NEUTROPHIL FUNCTION BY IN-VIVO FILGRASTIM TREATMENT FOR PROPHYLAXIS OF SEPSIS IN SURGICAL INTENSIVE-CARE PATIENTS

Purpose: To determine the kinetics of leukocyte counts and of oxygen r adical production of neutrophils from postoperative/posttraumatic pati ents with or without infusion of filgrastim (recombinant human granulo cyte colony-stimulating factor, rhG-CSF) as prophylaxis against sepsis . Methods: Twenty postoperative/posttraumatic patients with a Therapeu tic Intervention Scoring System (TISS) score greater than 30 were incl uded in this study. In the 10 patients of the study group, filgrastim (1 mu g/kg/d) was infused continuously within the first 3 days and tap ered to 0.5 mu g/kg/d on the following 4 days or until discharge from the surgical intensive care unit. Ten patients without administration of filgrastim served as controls. Oxygen radical production of isolate d neutrophils of these patients was tested by N-formyl-methionyl-leucy l-phenylalanine (FMLP)- and zymosan-induced chemiluminescence from ser ial blood samples, taken until the 16th postoperative day. Results: Co mpared with the first postoperative day, in vitro FMLP-induced neutrop hil chemiluminescence was significantly increased during the following 4 postoperative days in the patients with filgrastim infusion; howeve r, only during the first 2 postoperative days in the control group. Th e increase in the FMLP-induced neutrophil chemiluminescence was signif icantly greater (P < .05) in the study group than in the control group on the third and on the fourth postoperative day. Tapering of filgras tim by 0.5 mu g/kg/d in the study group resulted in a reduction of FML P-induced neutrophil oxygen radical production within 48 hours. In con trast, zymosan-induced neutrophil chemiluminescence was not measurably affected in both groups. Leukocyte count of the study group significa ntly (P < .05) exceeded the leukocyte count of the control group from the third up to the 10th postoperative day. None of the patients treat ed with filgrastim developed sepsis; however, three patients within th e control group did. Conclusions: Prolonged enhancement of neutrophil count and function induced by rhG-CSF may be useful in the prophylaxis of sepsis in posttraumatic/postoperative patients at high risk of sep sis. Copyright (C) l995 by W.B. Saunders Company