Gut bacterial translocation and postoperative infections: a prospective study in schistosomotic patients.
BACKGROUND
Bacterial translocation (BT) across the intact intestinal mucosal barrier has been postulated as a source of sepsis in susceptible patients, including those with cirrhosis and portal hypertension. This condition has not been studied in hepatosplenic schistosomiasis, wherein portal hypertension and the presence of an immune deficiency state associated with the parasitic disease could predispose to BT into mesenteric lymph nodes (MLN). A study was conducted to determine the prevalence of aerobic bacteria in MLN (bacterial translocation) of patients with hepatosplenic schistosomiasis, and establish a possible association with postoperative infections.


METHODS
In a series of 51 patients submitted to surgical treatment of schistosomotic portal hypertension with splenectomy and gastric devascularization, MLN were obtained from each patient at the beginning (MLN1) and at the end (MLN2) of the surgical procedure, and sent for bacteriological analysis. Prospective patient evaluation during the postoperative period correlated positive MLN cultures with infectious complications.


RESULTS
The prevalence of aerobic bacteria was 17.6% at MLN1 and 27.5% at MLN2, however, this difference was non-significant (p = 0.24). Bacterial translocation to all MLN was 22.5%. Escherichia coli was the most frequent organism (26.1%, 6/23). The overall incidence of postoperative infections was 19.6% (10/51), with a significant association with the presence of positive cultures of MLN (p = 0.043).


CONCLUSIONS
The findings of this study suggest that the presence of aerobic bacteria on MLN as a consequence of BT may play a role in the development of postoperative infectious complications, particularly in schistosomotic patients.
Ferraz
Alvaro Antônio Bandeira
AA
General Surgery Service, University Hospital of the Federal University of Pernambuco, Recife, Brazil. aabf@truenet.com.br
Campos
Josemberg Marins
JM
Júnior
José Guido Corrêa De Araújo
JG
De Albuquerque
Antônio Cavalcanti
AC
Ferraz
Edmundo Machado
EM
D000328:Adult; D000368:Aged; D018988:Bacterial Translocation / Q000276:immunology*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000276:immunology / Q000601:surgery*; D016867:Immunocompromised Host; D008198:Lymph Nodes / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012552:Schistosomiasis / Q000150:complications* / Q000276:immunology; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000209:etiology / Q000382:microbiology*