Microbial Translocation in Neonates and Infants Receiving Long-term Parenteral Nutrition

Pierro, Agostino; Saene, H. K. F. van; Donnell, S.C.; Hughes, Joseph P.; Ewan, C.; Nunn, Anthony J; Lloyd, David

doi:10.1001/archsurg.1996.01430140066018

Cited by 103 publications

(69 citation statements)

References 26 publications

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“…Another factor that likely contributes to increased sepsis in LIT candidates is bacterial overgrowth and translocation. 16,17 Although graft and patient survival results after LITs are currently inferior to the results seen after isolated liver transplantations, they have steadily improved as the experience with the intestinal transplantation increases, 5 and the early progress of LITs is not unlike that encountered with other solid organ transplantations. 18,19 Since 1997, the vast majority of LIT candidate deaths (85%) have occurred in status 2B, 3, or 7 candidates (Fig.…”

Section: Discussionmentioning

confidence: 99%

Mortality in candidates waiting for combined liver-intestine transplants exceeds that for other candidates waiting for liver transplants

Fryer

Pellar

Ormond³

et al. 2003

Liver Transplantation

141

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The United Network for Organ Sharing (UNOS) reports indicate that mortality on the intestine transplant waiting list is higher than on other transplant waiting lists. The goals of this study were (1) to determine whether most of the intestinal transplant candidate deaths have occurred in those who also need liver transplants, and (2) to compare the waiting list mortality in the liver-intestine candidate subset with the overall liver transplant candidate population. We found that 90% of intestine transplant waiting list deaths have occurred in candidates who also needed liver transplants. Since 1994, annual mortality has been higher in liver-intestine transplant candidates than in the overall liver transplant candidate population, and these differences have been statistically significant since 1996. These mortality differences applied to all age groups. Also, status 2B, 3, and 7 candidate mortality was significantly higher in liver-intestine candidates than in the overall liver transplant candidate population. Because there were so few liver-intestine transplant candidates listed as status 1 or 2A, a meaningful comparison was not possible in these statuses. These data indicate that liverintestine transplant candidates are a unique subset of liver transplant candidates with a significantly higher risk of dying on the waiting list. Recent changes in UNOS liver allocation policy that gives higher priority to liver-intestine candidates may help to reduce this discrepancy. However, further research into the etiology of liver disease in patients on long-term parenteral nutrition and earlier referral of high-risk short bowel syndrome patients to centers with special expertise in their management are needed for an ultimate solution to this problem. (Liver Transpl 2003;9:748-753.)

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Section: Discussionmentioning

confidence: 99%

Mortality in candidates waiting for combined liver-intestine transplants exceeds that for other candidates waiting for liver transplants

Fryer

Pellar

Ormond³

et al. 2003

Liver Transplantation

141

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“…Using molecular analysis, the authors provided genetic evidence that the strains isolated sequentially from cultures of stool, blood, and cerebrospinal fluid were identical. Pierro et al (46) studied neonates and infants receiving long-term parenteral nutrition. The authors found that six of 94 patients experienced 15 episodes of septicemia caused by bacteria of enteric origin; in all six patients, the causative organisms were also present in the throat or rectum.…”

Section: Discussionmentioning

confidence: 99%

Gut-Derived Bone Infection in the Neonatal Rat

et al. 2001

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The risk of osteomyelitis is increased in the premature and critically ill neonate. Although potential sites of bacterial entry are present in many of these infants, the source of infection frequently cannot be established. This study was performed to assess the possible role of bacterial translocation from the intestine in the origin of bone infection using models of breast-fed and formula-fed rat pups. Newborn Sprague-Dawley rats suckled either ad libitum by the dam (n ϭ 30), or were fed a rat milk-simulated formula (n ϭ 30). After 3 d, the animals were killed, and the left femur, heart blood, mesenteric lymph nodes, liver, spleen, and terminal ileum were excised. Organs were analyzed for bacteria by standard microbiologic procedures. Bacterial translocation occurred in 23% of breast-fed rats; the bone was not infected in any of these animals. After feeding of formula diet, bacterial counts of the ileum were markedly elevated (p Ͻ 0.001), and the composition of the gut flora was disrupted. Bacterial translocation was noted in all formula-fed rats. Bone cultures were positive in 23 of 30 (77%) rats after formula-feeding (p Ͻ 0.001 versus breast-feeding). Organisms translocated to the bone included Enterococci, Proteus, Enterobacter, and Escherichia coli. Bacterial species cultured from the bone correlated with the individual colonization pattern of other extraintestinal organs and with the composition of the ileal flora. Members of the gut flora can escape the intestine and colonize the bone in formula-fed rats. The gut should be considered as a potential source for osteomyelitis in the neonate. Acute osteomyelitis in the neonate is a leading cause of destruction of the physis resulting in high rates of permanent handicaps (1-3). Because the major route of infection is via the bloodstream, opportunities for organisms to gain access to the circulation may favor the development of osteomyelitis. Premature and sick neonates represent the high-risk group, and in this population potential sites of bacterial entrance are frequently present. Many of these infants undergo vascular manipulation including insertion of central catheters for total parenteral nutrition or invasive monitoring, which have long been linked to the development of skeletal infection. In most cases, however, the origin of bacterial entry remains unknown (4). Therefore, alternative routes of infection should be considered.Among the organisms causing neonatal osteomyelitis, Staphylococcus aureus is most common, followed by group B streptococci and Gram-negative bacteria (1, 5-7). All of these organisms have the ability to colonize the neonatal gut. They may represent normal luminal residents, or members of an abnormal microflora, as frequently seen in hospitalized neonates (8). It is now widely accepted that organisms can escape from the gastrointestinal tract and invade extraintestinal organs, a process termed as bacterial translocation (9, 10). In normal adult individuals, translocation of bacteria from the gastrointestinal tract is limited by a n...

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“…They reported six infants with 15 episodes of septicaemia attributable to enteric organisms. 15 Availability of laboratories round the clock would have been an important factor and particularly in our study where most of the emergency cases were included. But it was not feasible in our study as culture was done during the working hours only.…”

Section: Post-op Sepsismentioning

confidence: 99%

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

Thapa¹,

Hamal

Yadav

et al. 2014

J Lumbini Med Coll

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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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Microbial Translocation in Neonates and Infants Receiving Long-term Parenteral Nutrition

Abstract: In neonates and infants who are receiving PN, septicemia may be a gut-related phenomenon.

Cited by 103 publications

References 26 publications

Mortality in candidates waiting for combined liver-intestine transplants exceeds that for other candidates waiting for liver transplants

Mortality in candidates waiting for combined liver-intestine transplants exceeds that for other candidates waiting for liver transplants

Gut-Derived Bone Infection in the Neonatal Rat

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

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