Bacterial translocation studied in 927 patients over 13 years.

BACKGROUND: Bacterial translocation (BT) describes the passage of bacteria from the gastrointestinal tract to normally sterile tissues such as the mesenteric lymph nodes (MLNs) and other internal organs. The clinical and pathophysiological significance of BT remains controversial. This report describes results obtained over a 13-year period of study. METHODS: MLNs were obtained from 927 patients undergoing laparotomy. Nasogastric aspirates were obtained from 458 (49.4 per cent) of 927 patients for culture; pH was measured in 172 (37.6 per cent) of 458. Preoperative clinical variables were evaluated and factors that influenced BT were included in a multivariate logistic regression analysis. RESULTS: BT was identified in 130 (14.0 per cent) of 927 patients. Postoperative sepsis was more common in patients with BT (42.3 versus 19.9 per cent; P < 0.001). Independent preoperative variables associated with BT were emergency surgery (P = 0.001) and total parenteral nutrition (TPN) (P = 0.015). Gastric colonization was confirmed in 248 (54.1 per cent) of 458 patients, and was associated with both BT (P = 0.015) and postoperative sepsis (P = 0.029). A gastric pH of less than 4 was associated with a significant reduction in gastric colonization (53 versus 80 per cent; P < 0.001) and postoperative sepsis (46 versus 70.3 per cent; P = 0.018) but not BT. CONCLUSION: BT is associated with postoperative sepsis. Emergency surgery and TPN are independently associated with an increased prevalence of BT.