Bacterial Translocation In Patients Research Articles

Thoracic duct in patients with multiple organ failure: no major route of bacterial translocation.

To determine whether translocation of bacteria or endotoxin occurred into the thoracic duct in patients with multiple organ failure (MOF). Translocation of bacteria or endotoxin has been proposed as a causative factor for MOF in patients without an infectious focus, although it has rarely been demonstrated in patients at risk for MOF. Most studies have investigated the hematogenic route of translocation, but it has been argued that lymphatic translocation of bacteria or endotoxin by the thoracic duct is the major route of translocation. The thoracic duct was drained for 5 days in patients with MOF caused either by generalized fecal peritonitis (n = 4) or by an event without clinical and microbiologic evidence of infection (n = 4). Patients without MOF who were undergoing a transthoracic esophageal resection served as controls. In lymph and blood, concentrations of endotoxin, proinflammatory cytokines, and antiinflammatory cytokines were measured. Endotoxin concentrations in lymph and blood of patients with MOF ranged from 39 to 63 units per liter and were not significantly different from concentrations in patients without MOF. The quantity of endotoxin transported by the thoracic duct in the study group was small. In patients with MOF, low levels of proinflammatory cytokines and high levels of antagonists of these cytokines were found. This study provides evidence that translocation (especially of endotoxin) occurs into the thoracic duct. However, these data do not support the concept that the thoracic duct is a major route of bacterial translocation in patients with MOF.

The thoracic duct is not a major route of bacterial translocation in patients with multiple organ failure

The thoracic duct is not a major route of bacterial translocation in patients with multiple organ failure

The thoracic duct is not a major route of bacterial translocation in patients with multiple organ failure

The thoracic duct is not a major route of bacterial translocation in patients with multiple organ failure

Alterations in intestinal barrier function do not predispose to translocation of enteric bacteria in gastroenterologic patients.

Bacterial translocation from the intestinal lumen has been demonstrated in humans. Three mechanisms have been suggested to explain the phenomenon: altered intestinal barrier function, bacterial overgrowth, and impaired host defense. The aim of this study was to determine whether changes in intestinal barrier function assessed by measurement of intestinal permeability and morphology were associated with alteration in bacterial translocation. Intestinal permeability was assessed in 43 patients by the lactulose/L-rhamnose test with a 5-h urine collection. Mucosal atrophy was assessed from the villus height-to-mucosal thickness ratio in small-bowel biopsies. Bacterial translocation was determined by microbiologic analysis of harvested mesenteric lymph nodes. No significant differences were apparent in the incidence of bacterial translocation in patients with normal permeability (5 [23%] of 22 patients translocated) compared with patients with increased permeability (4 [19%] of 21 patients translocated). Similarly, no correlation was apparent between the incidence of bacterial translocation and the index of villus atrophy. The degree of villus atrophy failed to correlate with gastrointestinal permeability. These data suggest that the incidence of bacterial translocation is not related to increased intestinal permeability or mucosal atrophy.

Intestinal obstruction promotes gut translocation of bacteria

Translocation of enteric organisms has been implicated as a possible source of sepsis in susceptible patients. Animals studies have suggested that intestinal obstruction promotes bacterial translocation from the gut lumen. The aim of this study was to study the prevalence of bacterial translocation in patients with and without intestinal obstruction. Serosal scrapings, mesenteric lymph nodes, and peripheral blood cultures were obtained from 254 patients. Scrapings and nodes were homogenized and incubated aerobically and anaerobically. Full-thickness biopsies underwent villous height analysis. The clinical course was followed for at least six weeks. Bacterial translocation to mesenteric nodes occurred more frequently in patients with large bowel obstruction than in patients without obstruction (14 of 36 patients vs. 16 of 218 patients; P < 0.001). Both aerobic and anaerobic bacteria were found to translocate. The more distal the obstruction, the more likely anaerobic bacteria were to be identified. Translocation of bacteria predisposed to postoperative septic complications (P < 0.05). Villous height was not related to bacterial translocation. Gut translocation of bacteria is more common in patients with intestinal obstruction, and its association with septic complications appears to be of clinical significance.

Bacterial Translocation in Patients Undergoing Elective Colorectal Surgery

Bacterial translocation from the gastrointestinal tract into the mesenteric lymph nodes was studied in 39 patients operated on for colorectal carcinoma and in eight patients operated on for non-malignant colorectal diseases. Bacterial translocation was more common into lymph nodes with metastatic carcinoma than in uninvolved lymph nodes in patients with colorectal tumours and in lymph nodes from patients with benign colorectal diseases. More aerobic grampositive cocci were isolated from uninvolved lymph nodes than from involved lymph nodes and aerobic gram-negative rods were only recovered from uninvolved lymph nodes. There were more anaerobic strains found in the involved nodes compared to the uninvolved nodes. Postoperative infections related to the surgical procedure occurred in one patient. Measurable concentrations of cefoxitin, cefuroxime and metronidazole were found in the lymph nodes of the patients receiving these antimicrobial agents. Keywords: Bacterial translocation; Colorectal carcinoma; Elective surgery.

Bacterial Translocation in Patients Undergoing Elective Colorectal Surgery

Bacterial Translocation in Patients Undergoing Elective Colorectal Surgery