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Postinjury shock and early bacteremia. A lethal combination
F A Moore1, E E Moore, R S Poggetti
1Department of Surgery, General Hospital Denver, CO 80204-4507.
Archives of Surgery (Chicago, Ill. : 1960)
|August 1, 1992
Summary
Bacterial translocation is rarely the cause of early death after trauma. Enteric bacteria in the bloodstream were found only in dying patients, but their role remains unclear.
Area of Science:
- Trauma and Surgical Infections
- Microbiology
- Critical Care Medicine
Background:
- Gut bacteria translocation is hypothesized to cause early post-trauma mortality.
- Understanding the role of bacterial translocation in trauma outcomes is crucial for patient survival.
Purpose of the Study:
- To investigate the incidence and clinical significance of bacterial translocation in acutely injured patients.
- To determine the correlation between bacterial translocation and early mortality in trauma patients.
Main Methods:
- Blood cultures were obtained from 132 trauma patients undergoing laparotomy.
- Mesenteric lymph node and liver biopsy cultures were performed in a subset of patients.
- Incidence of bacteremia and specific bacterial species were analyzed in relation to patient shock status and outcomes.
Main Results:
- Early bacteremia occurred in 11% of patients without shock and 32% of patients with shock.
- Gram-positive bacteria were the most common isolates (73%).
- Enteric bacteremia was present in 18% of patients with shock, all of whom died; Staphylococcus isolates showed no clinical significance.
Conclusions:
- Bacterial translocation appears infrequent in trauma patients.
- Enteric bacteremia is strongly associated with mortality in trauma patients, though causality requires further investigation.
- Liver and lymph node cultures yielded bacteria infrequently and were generally not clinically significant.