Gastrointestinal Bacterial Translocation Research Articles

A prospective observational study of operating room traffic during shunt surgery: who comes in and why?

Shunt infections are costly and stressful for families, patients, and providers. Many institutions use shunt checklists in an effort to reduce the risk of infection following shunt surgery. Such protocols often aim to limit operating room (OR) foot traffic, but there is little evidence that supports the theory that greater OR traffic increases the risk of acquiring a shunt infection through contamination of the air. The purpose of this study was to quantify foot traffic during shunt surgery at a children's hospital during a time period when a shunt checklist was used. Starting in 2019, a premedical student was tasked with covertly collecting data on 50 shunt operations. Data were recorded in real time and documented in a prospectively updated database. Recording foot traffic through the OR door began at onset of skin prep; data points included patient and surgical details, operative length, and who entered the room and why. Each operation was followed for a minimum of 180 days for infection. The primary outcome was "door event," defined as any time a door to the OR was opened-fully or partially-with or without someone breaking the plane of the door (i.e., entering or exiting). Fifty operations were observed with no primary shunt infection (mean follow-up 29.8 months, range 6.5-63.3 months). One patient experienced a late secondary infection due to systemic post-COVID-19 inflammatory syndrome causing gastrointestinal bacterial translocation. The average operative time-from applying sterile skin prep until surgery stop time-was 69.8 minutes. Overall, there were 1012 door openings with 1088 personnel entering or exiting. The average number of door openings per operation was 20.24. OR personnel (42.7%) and neurosurgery staff (31.6%) were responsible for the largest number of door events, followed by the anesthesiology service (18.9%). The most cited reasons for door events were for supplies (31.2%) and scrubbing in (26.5%). This study represents the first detailed analysis of OR traffic during pediatric shunt surgery. No patient developed a primary shunt infection. While minimizing OR traffic makes intuitive sense, it remains unknown whether a causal relationship exists. Further investigation is needed.

Management of acute-onset pancreatitis in dogs: a Narrative Review.

Acute-onset pancreatitis (AP) is common in dogs and presents diagnostic as well as management challenges. Until recently, the management of AP in dogs was based mainly on supportive and symptomatic care. Identification and management of a possible cause of the disease is important, but the majority of cases are considered to be idiopathic. Fluid therapy that is tailored to the patient's needs is crucial to provide adequate hydration while preventing overhydration. Antiemetics are required to control vomiting and fluid loss and aid in early nutritional support. Recognition and management of complications is also crucial. Furthermore, analgesics for abdominal pain are very important. More recently, pharmaceutical modification of the inflammatory cascade has gained interest and the first specific therapeutic agent for the treatment of AP, fuzapladib sodium, has been shown to have a reasonable expectation of effectiveness in a pilot study. This drug has been licensed for the treatment of clinical signs of AP in dogs in Japan and also has achieved FDA conditional approval in the US. Antibiotics should not be used indiscriminately but are indicated for patients with aspiration pneumonia, gastrointestinal bacterial translocation, or evidence of another bacterial infection. Proton pump inhibitors and plasma are not routinely prescribed in pancreatitis unless specifically indicated. Nonsteroidal anti-inflammatory drugs should be avoided. Corticosteroid therapy, once thought to be contraindicated, may have some beneficial effects, as shown in a single retrospective study. However, further studies are required before their routine use can be recommended. Finally, a surgical approach is rarely indicated.

Bronchoscopy is associated with decreased mesenteric arterial flow*

We hypothesized that fiberoptic bronchoscopy can contribute to mesenteric ischemia and bacterial translocation. To test this hypothesis we investigated in patients undergoing bronchoscopy mesenteric blood flow and markers in association with ischemia reperfusion injury. Forty-seven consecutive patients requiring diagnostic fiberoptic bronchoscopy were studied. Parameters evaluated were superior mesenteric artery Doppler sonography, oxidative stress mediators, arterial blood gases, blood cultures pre-fiberoptic bronchoscopy, and 1st, 4th, and 24th hr post-fiberoptic bronchoscopy. After bronchoscopy; PaO2 decreased by 21.8% +/- 1.5% (range 6-40), and remained low at all time points (p = 0.0001, p = 0.0001, p = 0.008). Flow volume decreased by 38.8% +/- 14.9% (range 6-72), and remained low at 1st and 4th hr (p = 0.0001, p = 0.01). Resistive and pulsatile index increased at 1st hr (p = 0.0001, p = 0.001) and 4th hr (p = 0.018, p = 0.045). Myeloperoxidase and malondialdehyde increased at 1st hr (p = 0.0001) and 4th hr (p = 0.037, p = 0.028). Corresponding glutathione and catalase decreased at 1st hr (p = 0.0001), and glutathione remained significant at 4th and 24th hr (p = 0.0001, p = 0.003). Correlation between flow volume and PaO2 (r = .71, p = 0.0001), myeloperoxidase (r = -.39, p = 0.05), glutathione (r = .41, p = 0.03) was significant. Nine of 47 (19.1%) had fever, and 3 of 47 (6.4%) had gram-negative bacteremia. Fiberoptic bronchoscopy is associated with decreased mesenteric blood flow, which may place the patient at risk for mesenteric ischemia and gastrointestinal bacterial translocation.

Interleukin-2 Enhances the Translocation of Escherichia coli from the Intestines to Other Organs

To determine if interleukin-2 (IL-2) would inhibit gastrointestinal bacterial translocation, mice were gut-decontaminated and recolonized with Escherichia coli C25; some groups were pretreated with 200 mg/kg cyclophosphamide. IL-2 (1.68 mg/kg) or sterile diluent was injected twice daily for 3 or 5 days, and mice were sacrificed the next day. High cecal levels of E. coli C25 were present in all mice. The overall incidence of E. coli C25 translocation to mesenteric lymph nodes was not reduced by IL-2. The median numbers of translocated E. coli C25/g of mesenteric lymph node were significantly (P less than .005) higher after both 3 days (659 vs. 117) and 5 days (550 vs. 50) of treatment with IL-2 with cyclophosphamide and after 5 days (1784 vs. 225) of IL-2 without cyclophosphamide. IL-2 prevented neutropenia and exacerbated lymphopenia caused by cyclophosphamide. The in vitro growth of E. coli C25 was not affected by up to 10(5) units/ml IL-2. Ileal and cecal structures assessed by light and electron microscopy were not altered by IL-2. Thus, IL-2 unexpectedly enhanced the translocation of E. coli C25 from the gastrointestinal tracts of both cyclophosphamide-pretreated and normal mice.