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Bacterial translocation in multiple organ failure: cause or epiphenomenon still unproven
L C Lemaire1, J J van Lanschot, C P Stoutenbeek
1Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Background:
A body of evidence exists for the occurrence of bacterial translocation and its relationship to multiple organ failure (MOF).
Methods:
Relevant articles on bacterial translocation (the phenomenon defined as the passage of microbes and endotoxin across the intestinal barrier) in patients prone to develop MOF and in representative animal studies were selected. To interpret and evaluate the evidence for bacterial translocation in current literature, the endpoints generally used are discussed.
Results:
Fractional data from individual manuscripts were tabulated and assessed for statistical significance with chi 2 analysis. Various clinically relevant stimuli, postulated as important causative factors for the development of MOF, appeared to be interrelated and related to bacterial translocation itself.
Conclusions:
Convincing evidence exists that bacterial translocation can occur in humans during various disease processes. However, it remains to be determined whether a causal relationship between bacterial translocation and MOF exists. MOF is probably multifactorial and not uniform in origin; when evaluating translocation as a causative factor in the absence of an infective focus, the type of initiating event and the period of time after which MOF develops should be taken into account. The origin of early MOF is probably a non-bacterial, extensive, inflammatory response resulting in massive generalized endothelial cell activation. Late MOF may be caused primarily by bacterial translocation inducing an imbalance between proinflammatory and anti-inflammatory cytokines.
Insights
Bacterial translocation, the movement of microbes across the gut barrier, is linked to multiple organ failure (MOF). While it occurs in humans, its direct causal role in MOF requires further investigation.
Area of Science:
- Gastroenterology
- Critical Care Medicine
- Microbiology
Background:
- Evidence suggests a link between bacterial translocation and multiple organ failure (MOF).
- Bacterial translocation involves the passage of microbes and endotoxin across the intestinal barrier.
Purpose of the Study:
- To evaluate the evidence for bacterial translocation in patients at risk for MOF.
- To interpret the endpoints used in current literature regarding bacterial translocation.
Main Methods:
- Systematic review of relevant articles on bacterial translocation.
- Analysis of patient data and animal studies.
- Statistical assessment using chi-squared analysis.
Main Results:
- Clinically relevant stimuli for MOF appear interrelated and linked to bacterial translocation.
- Data suggest bacterial translocation occurs in humans during various disease processes.
Conclusions:
- Bacterial translocation is a confirmed phenomenon in human diseases.
- A definitive causal link between bacterial translocation and MOF is not yet established.
- MOF is likely multifactorial; early MOF may stem from inflammation, while late MOF might involve bacterial translocation and cytokine imbalance.