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Bacterial translocation in trauma patients
A B Peitzman1, A O Udekwu, J Ochoa
1Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania 15261.
Abstract:
Sepsis and multiple system organ failure (MSOF) are major causes of morbidity and mortality in trauma patients. Bacterial translocation induced by hypotension, endotoxemia, or burns is a reproducible phenomenon in the laboratory. The incidence of bacterial translocation to mesenteric lymph nodes (MLNs) in 29 critically ill patients was evaluated to determine its relationship to subsequent sepsis and MSOF. Bacterial translocation was documented in 3 of 4 patients who underwent laparotomy for gastrointestinal (GI) disease. No trauma patient (25 patients), even at second exploration 3-5 days after injury, had a positive MLN culture. Five patients died; 4 trauma patients, one with GI disease. Forty percent of the trauma patients had major complications, predominantly pulmonary infections with gram-negative bacteria. However, infectious complications and outcome were not related to MLN culture results. The classical progression of bacteria from the gut to the bloodstream via the MLNs may require time and gut mucosal injury. The data suggest that bacterial translocation to the MLNs is not a common occurrence in acutely injured trauma patients.
Insights
Bacterial translocation to mesenteric lymph nodes (MLNs) is uncommon in trauma patients, even with severe injuries. This study found no link between MLN bacterial presence and sepsis or organ failure in critically ill trauma survivors.
Area of Science:
- Trauma critical care
- Gastroenterology
- Infectious disease
Background:
- Sepsis and multiple system organ failure (MSOF) are significant causes of death in trauma patients.
- Bacterial translocation from the gut is a known phenomenon, often studied in laboratory settings.
- Its incidence and clinical relevance in critically ill trauma patients remain unclear.
Purpose of the Study:
- To evaluate the incidence of bacterial translocation to mesenteric lymph nodes (MLNs) in critically ill trauma patients.
- To determine the relationship between MLN bacterial translocation and subsequent sepsis or MSOF.
- To compare findings in trauma patients with those undergoing laparotomy for gastrointestinal disease.
Main Methods:
- Prospective evaluation of 29 critically ill patients (25 trauma, 4 GI disease).
- Collection of mesenteric lymph node (MLN) cultures during surgery or exploration.
- Correlation of MLN culture results with clinical outcomes, including sepsis, MSOF, and mortality.
Main Results:
- Bacterial translocation to MLNs occurred in 3 of 4 patients with gastrointestinal disease.
- No trauma patients (n=25), even after repeat exploration, showed positive MLN cultures.
- Infectious complications and patient outcomes were not associated with MLN culture findings.
Conclusions:
- Bacterial translocation to MLNs is not a frequent event in acutely injured trauma patients.
- The typical gut-to-bloodstream bacterial progression via MLNs may necessitate prolonged periods and gut mucosal damage.
- Findings suggest current models of bacterial translocation may not fully represent the acute trauma setting.