Bacterial translocation in patients undergoing major gastrointestinal surgery and its role in postoperative sepsis

Background—Gut translocation of bacteria has been shown in both animal and human studies. Evidence from animal studies that links bacterial translocation to the development of postoperative sepsis and multiple organ failure has yet to be confirmed in humans.Aims—To examine the spectrum of bacteria involved in translocation in surgical patients undergoing laparotomy and to determine the relation between nodal migration of bacteria and the development of postoperative septic complications.Methods—Mesenteric lymph nodes (MLN), serosal scrapings, and peripheral blood from 448 surgical patients undergoing laparotomy were analysed using standard microbiological techniques.Results—Bacterial translocation was identified in 69 patients (15.4%). The most common organism identified wasEscherichia coli (54%). Both enteric bacteria, typical of indigenous intestinal flora, and non-enteric bacteria were isolated. Postoperative septic complications developed in 104 patients (23%). Enteric organisms were responsible in 74% of patients. Forty one per cent of patients who had evidence of bacterial translocation developed sepsis compared with 14% in whom no organisms were cultured (p<0.001). Septic morbidity was more frequent when a greater diversity of bacteria resided within the MLN, but this was not statistically significant.Conclusion—Bacterial translocation is associated with a significant increase in the development of postoperative sepsis in surgical patients. The organisms responsible for septic morbidity are similar in spectrum to those observed in the mesenteric lymph nodes. These data strongly support the gut origin hypothesis of sepsis in humans.

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Gut origin of sepsis: a prospective study investigating associations between bacterial translocation, gastric microflora, and septic morbidity

Gut ◽

10.1136/gut.45.2.223 ◽

1999 ◽

Vol 45 (2) ◽

pp. 223-228 ◽

Cited By ~ 262

Author(s):

J MacFie ◽

C O’Boyle ◽

C J Mitchell ◽

P M Buckley ◽

D Johnstone ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Bacterial Translocation ◽

Postoperative Sepsis ◽

Mesenteric Lymph Nodes ◽

Septic Complications ◽

E Coli ◽

Mesenteric Lymph ◽

Septic Focus ◽

Gastric Microflora

AIMSTo investigate the “gut origin of sepsis” hypothesis.METHODSProspective controlled study of 279 surgical patients in which cultures of nasogastric aspirates were compared with those obtained from mesenteric lymph nodes taken at laparotomy and the organisms cultured from subsequent septic complications. Bacterial translocation was confirmed if positive cultures were obtained from mesenteric lymph nodes. Postoperative sepsis was defined as any positive culture in the postoperative period. Bacterial species obtained in gastric microflora, mesenteric lymph nodes, and postoperative septic complications were compared.RESULTSOnly 85/279 patients (31%) had a sterile nasogastric aspirate; the most frequently identified organism was Candida spp. (54%) and the most common enteric organism cultured was E coli (20%). Multiple organisms were isolated in 39% and occurred more frequently in patients aged over 70 years, those undergoing non-elective surgery, and in those requiring proximal gastrointestinal surgery. Postoperative sepsis was more common in these patients. Bacterial translocation occurred in 21% and was significantly more frequent in those with multiple organisms in their nasogastric aspirates. E coli was the commonest organism isolated from the lymph node specimens (48%) and septic foci (53%). Fungal translocation did not occur. An identical genus was identified in the nasogastric aspirate and the septic focus in 30% of patients, in the nasogastric aspirate and the lymph node in 31%, and in the lymph node and a postoperative septic focus in 45%.CONCLUSIONSProximal gut colonisation is associated with both increased bacterial translocation and septic morbidity. The commonality of organisms identified supports the gut origin of sepsis hypothesis.

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Clinical importance of “occult-bacterial translocation” in patients undergoing highly invasive gastrointestinal surgery: A review

Surgery Today ◽

10.1007/s00595-020-02126-z ◽

2020 ◽

Cited By ~ 1

Author(s):

Yukihiro Yokoyama ◽

Masahide Fukaya ◽

Takashi Mizuno ◽

Tomoki Ebata ◽

Takashi Asahara ◽

...

Keyword(s):

Bacterial Translocation ◽

Gastrointestinal Surgery ◽

Clinical Importance

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P405 EFFECT OF OPTIMISATION OF INTESTINAL FUNCTION ON BACTERIAL TRANSLOCATION, SIRS AND SEPTIC MORBIDITY IN PATIENTS UNDERGOING ELECTIVE GASTROINTESTINAL SURGERY

Clinical Nutrition Supplements ◽

10.1016/s1744-1161(08)70467-8 ◽

2008 ◽

Vol 3 ◽

pp. 200-201

Author(s):

R.R. Kallam ◽

M. Rao ◽

R. Arsalanizadeh ◽

J. MacFie

Keyword(s):

Bacterial Translocation ◽

Gastrointestinal Surgery ◽

Intestinal Function

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The Role of Probiotics and Synbiotics in Preventing Postoperative Sepsis in Gastrointestinal Surgery

Abdomen ◽

10.14800/abdomen.1462 ◽

2018 ◽

Vol 4 ◽

Keyword(s):

Gastrointestinal Surgery ◽

Postoperative Sepsis

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Bacterial Translocation as a Cause of Postoperative Sepsis in Surgical Patients Undergoing Laparotomy

Journal of Lumbini Medical College ◽

10.22502/jlmc.v2i2.53 ◽

2014 ◽

Vol 2 (2) ◽

pp. 28

Author(s):

Neeraj Thapa ◽

Bhairav Kumar Hamal ◽

Nagendra Prashad Yadav ◽

Ghanashyam Thapa

Keyword(s):

Lymph Nodes ◽

Bacterial Translocation ◽

Enteric Bacteria ◽

Surgical Patients ◽

Postoperative Sepsis ◽

Mesenteric Lymph Nodes ◽

Septic Complications ◽

Emergency Procedures ◽

Mesenteric Lymph ◽

Postoperative Septic Complications

Introduction: Bacterial translocation is the invasion of indigenous intestinal bacteria through the gut mucosa to normally sterile tissues and the internal organs. Objective of the study is to examine the spectrum of bacteria involved in translocation in surgical patients undergoing laparotomy and to determine the relation between nodal migration of bacteria and the development of postoperative septic complications. Methods: Mesenteric lymph nodes (MLN)culture was done in patients undergoing elective and emergency surgeries fulfilling the inclusion criteria. Results:Bacterial translocation was identified in 22 (44.8%) patients. The most common organism identified was Escherichia coli (n=11, 50%). Both enteric bacteria, typical of indigenous intestinal flora, and non-enteric bacteria were isolated. Postoperative septic complications developed in four (11%) patients. Septic morbidity was more frequent when a greater diversity of bacteria resided within the mesenteric lymph nodes. Conclusion: Bacterial translocation is associated with an increase in the development of postoperative sepsis in surgical patients. The organisms responsible for septic morbidity are similar in spectrum to those observed in the mesenteric lymph nodes. These data strongly support the gut origin hypothesis of sepsis in humans. Besides, there is increased bacterial translocation in patients undergoing emergency procedures. Keywords: bacteria • laparotomy • postoperative • sepsis • translocation

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