Microbial translocation and inflammatory response in patients with acute peritonitis

Abstract

Background: In peritonitis, increased production of cytokines and changes in the splanchnic cellular immune system may cause translocation of bacteria and endotoxins. The aims of this study were to assess the frequency of translocation and relate translocation to the immune response in patients with acute peritonitis. Methods: Patients with local (LP, n = 20) or general peritonitis (GP, n = 15) were compared with controls (C, n = 12). Blood was obtained preoperatively for cultures, and analyses of endotoxin and cytokines (tumour necrosis factor‐α, interleukins 6 and 10). Mesenteric lymph nodes (MLNs) were excised for culturing and immunohistochemistry using antibodies CD4, CD8 and CD68. Results: Positive blood and MLN cultures were not obtained in controls. DNA typing proved bacterial translocation in one patient with local and one patient with general peritonitis. Thus translocation was proven to occur in 6% of patients with peritonitis. Endotoxaemia was predominantly found in the GP group. Cytokines increased during peritonitis and more so in patients with GP than in those with LP. More CD8+and CD68+cells were found in MLNs from LP patients than in C patients and more CD4+and CD8+cells in LP patients than in GP patients. There was no significant difference in this regard between the GP and C groups. Conclusions: Bacterial translocation occurs during acute peritonitis but seems to be fairly infrequent. Peritonitis causes significant inflammatory cellular reactions.