Bacterial translocation following abdominal trauma in humans.

Abstract

Bacterial translocation in humans has been identified only with small bowel obstruction and in trauma patients. Our aim was to determine whether the occurrence of bacterial translocation correlates with clinical outcome in trauma patients. All patients requiring exploratory celiotomy for abdominal trauma over a 2-month period were considered for the study. Gross fecal contamination of the abdomen was the only exclusion criterion. Five patients with small bowel injuries without obvious contamination were included. Patients received preoperative antibiotics. Once surgical hemostasis and injury repair were complete, two mesenteric lymph nodes were harvested--one for quantitative culture, the other for electron microscopic evaluation. Postoperatively, patients were monitored for infection via temperature, white blood cell (WBC) count, and, when indicated, chest X-ray (CXR) and culture. Statistical analysis utilized ANOVA (P < 0.05 significant) and linear regression. Sixteen patients were included in the study. Fifteen patients sustained penetrating abdominal trauma, one blunt. Six patients presented in Class I hemorrhagic shock, four in Class II, and two in Class III. The remaining four were not in hemorrhagic shock. Thirteen patients demonstrated bacterial translocation: one by culture alone, nine by electron microscopy, and three by both culture and electron microscopy. Statistical analysis of these three groups and patients without evidence of infection failed to reveal significant difference in average age, injury severity, hospital days, or incidence of postoperative infection. Bacterial translocation occurs following abdominal trauma in humans. Electron microscopic evaluation of mesenteric lymph nodes demonstrated that the incidence of translocation is greater than anticipated by culture alone.(ABSTRACT TRUNCATED AT 250 WORDS)