Die Insuffizienz der intraabdominellen Infektabwehr bei der eitrigen Peritonitis

Despite a high concentration of serum proteins and intact
phagocytes peritonitis exudates contain a large number of viable,
pathogenic bacteria. The reason for this biological paradox is
unknown. Our investigations reveal a pronounced defect in humoral
opsonization of foreign particles in peritonitis exudate. We
evaluated a modified chemiluminescence system allowing the
determination of opsonic activity in serum and exudate. In serum we
found a close correlation between opsonic activity and
immunologically measurable levels of C3-complement and IgG. In
purulent peritonitis exudates, however, the actual opsonizing
activity was much less than expected according to the opsonin
concentrations. We found a pronounced difference between
immunologically determined opsonin levels and impaired opsonic
function. Employing crossed immunoelectrophoresis massive
C3-splitting into smaller fragments could be demonstrated in
peritonitis exudates. In these exudates we found very high
concentrations of granulocyte proteolytic (elastase) and oxidative
(myeloperoxidase) enzymes which may lead to a functional
destruction of opsonins followed by impaired opsonization in
peritonitis exudate. The great number of bacteria and foreign
particles in addition can cause a pronounced physiological
consumption of complement components. The almost complete breakdown
of intact C3-complement in intraabdominal exudate explains the
deficient host defence in patients with severe peritonitis.