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[Bacterial translocation in multiple organ failure]
R Fukushima1, S Kobayashi, K Okinaga
1Department of Surgery II, Teikyo University School of Medicine, Tokyo, Japan.
Abstract:
Bacterial translocation has been defined as the passage of both viable and nonviable bacteria and their products (e.g., endotoxins) across the intestinal barrier to extraintestinal sites such as the mesenteric lymph nodes, liver, etc. It has been hypothesized that intestinally derived bacteria or endotoxins serve as triggers to initiate, perpetuate, or exacerbate the septic state and thereby promote the development of multiple organ failure (MOF). In various animal studies, bacterial translocation has been associated with mortality and septic complications. Although most data on translocation have been derived from animal studies, convincing evidence has been provided that translocation may occur in humans during various disease states. The question still remains, however, of whether bacterial translocation is an important pathophysiological event in human disease or simply an epiphenomenon of severe disease, since the results are variable. Recent studies have indicated that the gut can produce important amounts of immunoinflammatory factors and that intestinal injury predisposes to distant organ injury even in the absence of detectable bacteria or endotoxins in the portal blood or tissues. This hypothesis may in part explain the inconsistent causal relationship between bacterial translocation and MOF.
Insights
Bacterial translocation, the movement of gut bacteria and endotoxins, may contribute to sepsis and organ failure. However, its role in human disease remains debated, potentially being an epiphenomenon rather than a direct cause.
Area of Science:
- Gastroenterology
- Immunology
- Critical Care Medicine
Context:
- Bacterial translocation (BT) involves the movement of bacteria and endotoxins from the gut to other body sites.
- BT is hypothesized to trigger or worsen sepsis and multiple organ failure (MOF).
- Evidence suggests BT occurs in humans, but its significance is debated.
Purpose:
- To review the evidence for bacterial translocation in human disease.
- To discuss the potential role of BT in the pathogenesis of sepsis and MOF.
- To explore alternative hypotheses for distant organ injury.
Summary:
- BT is defined as the passage of bacteria and endotoxins across the intestinal barrier.
- Animal studies link BT to mortality and sepsis, but human data are variable.
- Recent findings suggest the gut produces inflammatory factors, and intestinal injury can cause organ damage independently of detectable BT.
Impact:
- Clarifies the complex relationship between bacterial translocation and multiple organ failure.
- Highlights the potential role of the gut as a source of inflammatory mediators.
- Suggests that intestinal injury, not just bacterial translocation, may drive distant organ damage in critical illness.