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C J O'Boyle Combined Gastroenterology
Service, Scarborough Hospital, Scalby Road, Scarborough, North
Yorkshire, UK
Correspondence to: Mr MacFie. Accepted for publication 29 July 1997 Background Keywords:
bacterial translocation;
mesenteric lymph nodes;
serosal scrapings;
enteric bacteria;
postoperative sepsis
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.
AimsTo 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.
MethodsMesenteric lymph nodes (MLN), serosal
scrapings, and peripheral blood from 448 surgical patients undergoing
laparotomy were analysed using standard microbiological techniques.
ResultsBacterial translocation was identified in
69 patients (15.4%). The most common organism identified was
Escherichia 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.
ConclusionBacterial 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.
(GUT 1998;42:29-35)
© 1998 by Gut
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