Immunosuppression and Intestinal Bacterial Overgrowth Synergistically Promote Bacterial Translocation

Berg, Rodney D.; Wommack, Ellen; Deitch, Edwin A.

doi:10.1001/archsurg.1988.01400350073011

Cited by 164 publications

(69 citation statements)

References 14 publications

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“…Our study also found that recent antibiotic use was the main risk factor for development of ARE peritonitis. Ingestion of antibiotic results in elimination of the normal gastrointestinal flora and provokes transmural migration of enterococci to the peritoneal cavity (21). We previously reported an association of gastric-acid inhibitor treatment with the development of multi-antibiotic-resistant E. coli peritonitis (22).…”

Section: Discussionmentioning

confidence: 99%

Clinical Course and Outcomes of Single-Organism Enterococcus Peritonitis in Peritoneal Dialysis Patients

Yip

Tse

et al. 2011

Perit Dial Int

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♦ Background and Objectives: Enterococci are part of the normal flora of the gastrointestinal tract. They can cause enteric peritonitis, which is a serious complication of peritoneal dialysis (PD). However, the clinical course and outcome of PD-related Enterococcus peritonitis remains unclear. ♦ Methods: We reviewed all Enterococcus peritonitis episodes occurring in our dialysis unit from 1995 to 2009. ♦ Results: During the study period, 1421 episodes of peritonitis were recorded. Of 29 episodes (2.0%) that were attributable to single-organism Enterococcus, 12 episodes were caused by E. faecalis; 9, by E. faecium; and the remaining 8, by other Enterococcus species. The overall rate of ampicillin resistance was 41.4%. Recent use of antibiotics was associated with the development of ampicillin-resistant Enterococcus (ARE) peritonitis (hazard ratio: 12.53; p = 0.04). The primary response rate of Enterococcus peritonitis was significantly higher than that of Escherichia coli peritonitis (89.7% vs. 69.9%, p = 0.038), but the primary response rate was not significantly lower for ARE peritonitis than for ampicillin-susceptible Enterococcus (ASE) peritonitis (83.3% vs. 94.1%, p = 0.553). However, significantly more patients with ARE had received vancomycin (83.3% vs. 23.5%, p = 0.003), with a longer mean duration of vancomycin treatment (11.8 ± 6.9 days vs. 3.7 ± 6.8 days, p = 0.005). ♦ Conclusions: Recent use of antibiotics was a risk factor for the development of ARE peritonitis. Outcomes in ASE and ARE peritonitis were similar, but vancomycin was required during treatment for ARE peritonitis, in turn possibly predisposing the patients to infections caused by vancomycin-resistant organisms.

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Section: Discussionmentioning

confidence: 99%

Clinical Course and Outcomes of Single-Organism Enterococcus Peritonitis in Peritoneal Dialysis Patients

Yip

Tse

et al. 2011

Perit Dial Int

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“…Numerous studies have shown that shock, parenteral nutrition, and antibiotics facilitate the translocation of enteric bacteria. [26][27][28][29][30][31] Gastric alkalinization, with concomitant bacterial and fungal overgrowth, in critically ill ICU patients receiving multiple antibiotics may facilitate the translocation of Candida. Further studies will be necessary to confirm this finding.…”

Section: Discussionmentioning

confidence: 99%

Has the Epidemiology of Nosocomial Candidemia Changed?

Puzniak

Teutsch

Powderly

et al. 2004

Infect. Control Hosp. Epidemiol.

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Objective:To assess changes in the epidemiology of nosocomial candidemia in the post-fluconazole era among hospitalized patients using a case–control study design.Design:Candidemia case-patients were matched 1:1 on diagnosis, age, and length of stay with control-patients. Conditional logistic regression was used to determine predictors and outcomes of candidemia. Treatment regimens and compliance with national practice guidelines were compared among case-patients.Setting:Barnes-Jewish Hospital, a 1,278-bed, tertiary-care center affiliated with Washington University School of Medicine, St. Louis, Missouri.Participants:Patients admitted from January 1 to December 31, 2000. Case-patients were identified through the hospital microbiological surveillance system and matched with control-patients.Results:Predictors of candidemia included Hickman catheters (odds ratio [OR], 9.53; 95% confidence interval [CI95], 1.34 to 68.01), gastric acid suppressants (OR, 6.38; CI95, 2.33 to 17.43), nasogastric tubes (OR, 3.69; CI95, 1.27 to 10.78), antibiotics (OR, 1.46; CI95,1.15 to 1.86), and admission to the intensive care unit (OR, 6.40; CI95, 2.12 to 19.31). The crude case-fatality rate was 40%. Seventeen (15%) of the case-patients received the recommended treatment regimen according to recently published practice guidelines.Conclusions:The epidemiology of candidemia has changed little at our hospital during the past decade and remains a significant cause of mortality. Further studies on the benefits of preventive therapy will be essential to improve the outcome of this infection.

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“…The indigenous gut flora is thought to be an important source of potential septicemia in immunocompromised patients, such as burn patients [2,3,81. During the aging process, normal immune responses diminish and sensiti vity to infection increases.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, immuno suppressive agents such as cyclophosphamide (CY) promote bacterial translocation [2,3], the effects of treatment with these agents on bacterial translocation at different ages is also unknown. To answer these questions, we exam ined the bacterial translocation from the GI tract in mice at 1, 2, 4, 6, 12, and 15 months of age.…”

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confidence: 99%

Effect of Age on Bacterial Translocation from the Gastrointestinal Tract in Mice

Ohsugi

Kurosawa

Maejima

1992

Experimental Animals

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To clarify the effects of age on bacterial translocation from the gastrointestinal tract, mice at the age of 1, 2, 4, 6, 12, and 15 months were antibiotic -decontam inated for 4 days and then inoculated orally with streptomycin-resistant Escheri chia coli C25. Mice treated with cyclophosphamide and untreated controls were tested for bacterial translocation to the mesenteric lymph nodes (MLN) 2 days later. The population levels of E. coli C25 in cyclophosphamide-treated and untreat ed mice were approximately 109' a and 109' S per gram of cecum, respectively, at each tested age. There were no significant differences in the incidence of transloca tion of E. coli C25 to MLN at any of the tested ages, whereas the number of E. coli C25 detected in MLN was higher in young mice than in aged mice in both the cyclophosphamide-treated and untreated groups. These findings suggest that bacterial translocation from the GI tract may be a more important problem in young animals than in aged animals.

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Immunosuppression and Intestinal Bacterial Overgrowth Synergistically Promote Bacterial Translocation

Cited by 164 publications

References 14 publications

Clinical Course and Outcomes of Single-Organism Enterococcus Peritonitis in Peritoneal Dialysis Patients

Clinical Course and Outcomes of Single-Organism Enterococcus Peritonitis in Peritoneal Dialysis Patients

Has the Epidemiology of Nosocomial Candidemia Changed?

Effect of Age on Bacterial Translocation from the Gastrointestinal Tract in Mice

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