Gut origin of sepsis: a prospective study investigating associations between bacterial translocation, gastric microflora, and septic morbidity.
OBJECTIVE
To investigate the "gut origin of sepsis" hypothesis.


METHODS
Prospective controlled study of 279 surgical patients in which cultures of nasogastric aspirates were compared with those obtained from mesenteric lymph nodes taken at laparotomy and the organisms cultured from subsequent septic complications. Bacterial translocation was confirmed if positive cultures were obtained from mesenteric lymph nodes. Postoperative sepsis was defined as any positive culture in the postoperative period. Bacterial species obtained in gastric microflora, mesenteric lymph nodes, and postoperative septic complications were compared.


RESULTS
Only 85/279 patients (31%) had a sterile nasogastric aspirate; the most frequently identified organism was Candida spp. (54%) and the most common enteric organism cultured was E coli (20%). Multiple organisms were isolated in 39% and occurred more frequently in patients aged over 70 years, those undergoing non-elective surgery, and in those requiring proximal gastrointestinal surgery. Postoperative sepsis was more common in these patients. Bacterial translocation occurred in 21% and was significantly more frequent in those with multiple organisms in their nasogastric aspirates. E coli was the commonest organism isolated from the lymph node specimens (48%) and septic foci (53%). Fungal translocation did not occur. An identical genus was identified in the nasogastric aspirate and the septic focus in 30% of patients, in the nasogastric aspirate and the lymph node in 31%, and in the lymph node and a postoperative septic focus in 45%.


CONCLUSIONS
Proximal gut colonisation is associated with both increased bacterial translocation and septic morbidity. The commonality of organisms identified supports the gut origin of sepsis hypothesis.
Combined Gastroenterology Department, Scarborough Hospital, North Yorkshire YO12 6QL, UK.
J
J
MacFie
C
C
O'Boyle
C J
CJ
Mitchell
P M
PM
Buckley
D
D
Johnstone
P
P
Sudworth
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology*; D018988:Bacterial Translocation / Q000502:physiology*; D002175:Candida / Q000302:isolation & purification / Q000502:physiology; D016022:Case-Control Studies; D002648:Child; D004926:Escherichia coli / Q000302:isolation & purification / Q000502:physiology*; D005260:Female; D016469:Fungemia / Q000382:microbiology*; D006801:Humans; D007422:Intestines / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000382:microbiology*; D011446:Prospective Studies; D013270:Stomach / Q000382:microbiology