Bacterial translocation

The clinical importance of bacterial translocation in trauma patients is still a matter of controversy ( Nle..u.w.e.n^ 1996).

Bacterial translocation is promoted by one or more of the following three factors: bacterial overgrowth, impaired host immune defense, and physical disruption of the mucosal barrier of the gut. In patients suffering from abdominal trauma, these conditions arise owing to intestinal injury, hemorrhagic shock, administration of antibiotics, and parenteral feeding.

Increased intestinal permeability after major trauma is a well-known phenomenon (Roumeneial., 1993); however, bacterial translocation is not observed after trauma

The incidence of bacterial translocation in non-trauma patients shows a distinct variability. If the mesenteric lymph nodes are sampled, 6 to 81 per cent contain bacteria depending on the bacterial determination technique (cultures versus electron microscopy). The relationship between increased permeability and bacterial translocation with subsequent infectious complications has not been clearly established.

Experimentally, elevated serum endotoxin results in splanchnic ischemia and increased intestinal permeability. However, in patients suffering from severe trauma or hemorrhagic shock, endotoxin levels, if elevated, are independent of increased intestinal permeability. It has been suggested that increased intestinal permeability, bacterial translocation, endotoxemia, and infectious complications are essentially independent phenomena which occur frequently in seriously injured patients.

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