Gastric colonization predisposes to septic morbidity in surgical patients: a prospective study

Several previous studies have suggested that pathological colonization of the proximal gastrointestinal (GI) tract may be associated with septic morbidity. However, the prevalence of this in surgical patients is unknown and there is little information on factors that might predispose to this phenomenon. The aim of this study was to assess the preoperative variables that are associated with pathological colonization of the proximal GI tract in surgical patients.

Nasogastric aspirates were obtained from 502 surgical patients to identify abnormal colonization. Several preoperative variables were tested to identify association with pathological colonization of the proximal GI tract. Postoperative septic morbidity was recorded prospectively in all patients.

Enterobacteriaceae were identified in 78 of 502 patients (15.5%), 124 of 502 (24.7%) had multiple organisms, and 157 of 502 (31.3%) had Candida in the nasogastric aspirates. Age >70 y and emergency surgery were associated with presence of Enterobacteriaceae. Age >70 y was also associated with the presence of multiple organisms (with or without Enterobacteriaceae). Colonization with Enterobacteriaceae or presence of multiple organisms in the proximal GI tract was associated with postoperative septic morbidity. Preoperative total parenteral nutrition was associated with Candida colonization in the upper GI tract, but not with sepsis.

Pathological colonization of the proximal GI tract with Enterobacteriaceae or multiple organisms is associated with increased incidence of postoperative sepsis. Age >70 y and emergency surgery were the two preoperative variables associated with pathological colonization in surgical patients. Preoperative total parenteral nutrition is associated with fungal colonization but this is not associated with septic morbidity.