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Critical Care Focus 9: The Gut - part 5

Sinh vật nhiều được phân lập ở 39% bệnh nhân và xảy ra thường xuyên hơn ở bệnh nhân trên 70 tuổi, những người trải qua phẫu thuật không tự chọn, và những người đòi hỏi phải phẫu thuật đường tiêu hóa gần. | CRITICAL CARE FOCUS THE GUT identified organism was Candida spp. and the most common enteric organism cultured was E. coli. Multiple organisms were isolated in 39 of patients and occurred more frequently in patients aged over 70 years those undergoing non-elective surgery and those requiring proximal gastrointestinal surgery. Post-operative sepsis was also more common in these patients. Bacterial translocation occurred in 21 of patients but fungal translocation did not occur. It was concluded that proximal gut colonisation was associated with both increased bacterial translocation and septic morbidity. To examine the spectrum of bacteria involved in translocation in surgical patients undergoing laparotomy and to determine the relation between nodal migration of bacteria and the development of post-operative septic complications O Boyle et al. analysed mesenteric lymph nodes serosal scrapings and peripheral blood from 448 surgical patients undergoing laparotomy using standard microbiological techniques.8 Bacterial translocation was identified in 69 patients 15-4 the most common organism isolated being Escherichia coli 54 . Both enteric and non-enteric bacteria were isolated. Post-operative septic complications developed in 104 patients 23 and enteric organisms were responsible in 74 of patients. In the patients who had evidence of bacterial translocation 41 developed sepsis compared with only 14 in whom no organisms were cultured. This study again showed that bacterial translocation is associated with the development of post-operative sepsis in surgical patients. These data once more support the gut origin hypothesis of sepsis in humans. Accumulating data suggest that a number of diseases are associated with microbial translocation in humans including those in which the gut flora is altered where there are changes in intestinal physiology or which have been preceded by intestinal inflammation or ischaemia Box 4.1 . The role of endotoxin The translocation of viable .