The presence of hemorrhagic shock increases the rate of bacterial translocation in blunt abdominal trauma.

Abstract

Sepsis and multisystem organ failure are common after hemorrhagic shock. The aims of this study were to determine whether hemorrhagic shock would promote the translocation of bacteria and if it correlates with clinical outcome in patients with blunt abdominal trauma. Twenty-six patients requiring laparotomy for blunt abdominal trauma (group I) and 30 patients operated electively (group II) were studied. Injury Severity Score, Trauma Score, and Acute Physiology and Health Evaluation (APACHE) II score were recorded before the operation. Peritoneal swab, mesenteric lymph node, portal venous blood, liver wedge biopsy, and spleen biopsy (in splenectomized patients) were sampled for culture after surgical hemostasis. Additionally, peripheral blood samples were taken preoperatively and postoperatively in group I patients for culture. The same samples were taken in group II patients except for the spleen biopsy. Moreover, patients in group I were further subdivided into subgroups A and B, indicating the presence or absence, respectively, of hemorrhagic shock (defined as systolic blood pressure < 90 mm Hg with identifiable blood loss). Postoperatively, patients were checked for infectious and septic complications. Mean Injury Severity Score, Trauma Score, and APACHE II score were 32.0, 12.1, and 10.9 in group I and 2.1 (APACHE II,p < 0.01) in group II, respectively. Two patients in group IA, eight patients in group IB, and one patient in group II demonstrated bacterial translocation (BT) (p < 0.01). Five patients with blunt abdominal trauma had major infectious complications, but only one had BT, and the same microorganism grew in the intra-abdominal abscess. There were two infectious complications in the control group. One of these patients had BT, and the same microorganism grew in the wound infection. We conclude that BT occurs after blunt abdominal trauma in humans and correlates with the presence of hemorrhagic shock, but the clinical significance of BT in trauma patients remains unclear.