Review article: bacterial translocation in the critically ill – evidence and methods of prevention

Abstract

Summary Background Delayed sepsis, systemic inflammatory response syndrome (SIRS) and multiorgan failure remain major causes of morbidity and mortality on intensive care units. One factor thought to be important in the aetiology of SIRS is failure of the intestinal barrier resulting in bacterial translocation and subsequent sepsis. Aim This review summarizes the current knowledge about bacterial translocation and methods to prevent it. Methods Relevant studies during 1966–2006 were identified from a literature search. Factors, which detrimentally affect intestinal barrier function, are discussed, as are methods that may attenuate bacterial translocation in the critically ill patient. Results Methodological problems in confirming bacterial translocation have restricted investigations to patients undergoing laparotomy. There are only limited data available relating to specific interventions that might preserve intestinal barrier function or limit bacterial translocation in the intensive care setting. These can be categorized broadly into pre‐epithelial, epithelial and post‐epithelial interventions. Conclusions A better understanding of factors that influence translocation could result in the implementation of interventions which contribute to improved patient outcomes. Glutamine supplementation, targeted nutritional intervention, maintaining splanchnic flow, the judicious use of antibiotics and directed selective gut decontamination regimens hold some promise of limiting bacterial translocation. Further research is required.

Effect of honey on bacterial translocation and intestinal morphology in obstructive jaundice

“…Obstructive jaundice is almost universally believed to promote bacterial translocation. Absence of bile from the lumen of gut is also associated with a quantitative increase in small intestinal microflora [18] . Translocation from the intestine is most commonly detected by measuring the presence of viable bacteria in the tissues.…”

Probiotic Bacillus amyloliquefaciens SC06 Prevents Bacterial Translocation in Weaned Mice

“…Three primary mechanisms promote BT from the gastrointestinal tract: (a) intestinal bacterial overgrowth, (b) immunodeficiencies, and (c) increased intestinal permeability [5,24]. BT may cause the ingress of viable bacteria and their antigens with the development of sepsis, initiation of the cytokines mediated multiorgan dysfunction syndrome (MODS), systemic inflammatory response syndrome (SIRS), and death [10]. Probiotics are defined as non-pathogenic live microorganisms that seem to promote gut health and regulate intestinal homeostasis [9,23].…”

Constipação intestinal em terapia intensiva

“…(21) Several studies have shown an association between dysfunction of intestinal motility and bacterial proliferation. (23)(24)(25)(26) In an experimental study Nieuwenhuijs et al compared infusion of morphine with placebo.…”

“…(21) Inflammatory mediators can increase intestinal permeability without necessarily damaging the mucosa. Cytokines may act as modulators of these structures and may thus increase permeability to antigens that promote onset of an intestinal inflammatory cascade.…”