Review article: bacterial translocation in the critically ill – evidence and methods of prevention
Article first published online: 23 OCT 2006
Alimentary Pharmacology & Therapeutics
Volume 25, Issue 7, pages 741–757, April 2007
How to Cite
GATT, M., REDDY, B. S. and MACFIE, J. (2007), Review article: bacterial translocation in the critically ill – evidence and methods of prevention. Alimentary Pharmacology & Therapeutics, 25: 741–757. doi: 10.1111/j.1365-2036.2006.03174.x
- Issue published online: 23 OCT 2006
- Article first published online: 23 OCT 2006
- Publication data Submitted 13 July 2006 First decision 18 August 2006 Resubmitted 30 September 2006 Accepted 01 October 2006
Delayed sepsis, systemic inflammatory response syndrome (SIRS) and multiorgan failure remain major causes of morbidity and mortality on intensive care units. One factor thought to be important in the aetiology of SIRS is failure of the intestinal barrier resulting in bacterial translocation and subsequent sepsis.
This review summarizes the current knowledge about bacterial translocation and methods to prevent it.
Relevant studies during 1966–2006 were identified from a literature search. Factors, which detrimentally affect intestinal barrier function, are discussed, as are methods that may attenuate bacterial translocation in the critically ill patient.
Methodological problems in confirming bacterial translocation have restricted investigations to patients undergoing laparotomy. There are only limited data available relating to specific interventions that might preserve intestinal barrier function or limit bacterial translocation in the intensive care setting. These can be categorized broadly into pre-epithelial, epithelial and post-epithelial interventions.
A better understanding of factors that influence translocation could result in the implementation of interventions which contribute to improved patient outcomes. Glutamine supplementation, targeted nutritional intervention, maintaining splanchnic flow, the judicious use of antibiotics and directed selective gut decontamination regimens hold some promise of limiting bacterial translocation. Further research is required.