Bacterial translocation studied in 927 patients over 13 years

MacFie, John; Reddy, B. S.; Gatt, M.; Jain, Prashant; Sowdi, R.; Mitchell, C. J.

doi:10.1002/bjs.5184

Cited by 175 publications

(133 citation statements)

References 27 publications

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“…28 In a surgery population, PN was independently associated with an increased prevalence of bacterial translocation. 29 PN was also associated with an increased risk of line infections and metabolic disturbances such as hyperglycaemia and hypertriglyceridaemia, cholestatic liver disease and fluid overload state. 5,20,32 PN potentiates hepato-biliary disorders that may contribute to cholestasis due to sepsis, drug toxicity and veno-occlusive disease in allo-SCT patients.…”

Section: Discussionmentioning

confidence: 99%

Enteral nutrition: a first option for nutritional support of children following allo-SCT?

Azarnoush

Bruno

Béghin

et al. 2012

Bone Marrow Transplant

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Parenteral nutrition (PN) is the treatment of choice for nutritional support of patients undergoing allo-SCT following myeloablative conditioning (MAC). Here we prospectively assessed the outcomes of early enteral nutrition (EN) in a paediatric cohort. From 2003 to 2010, all 65 consecutive children undergoing MAC allo-SCT at our referral centre began EN the day after transplantation. Post-transplant and nutritional outcomes of patients receiving only EN (EN group, n ¼ 50) were compared with those of patients requiring additional PN (EN-PN group, n ¼ 15). In the EN group time to platelet recovery (P ¼ 0.01) and length of hospitalisation (Po0.001) were shorter, while in the EN-PN group the proportion of unrelated donors (P ¼ 0.02) and the frequency of severe acute GVHD (aGVHD; P ¼ 0.004) were higher. All patients were alive at day 100. PN was started 14 days after transplant because of poor digestive tolerance to EN or severe gut aGVHD. The body mass index Z-score in the EN-PN group decreased from transplant to discharge (P ¼ 0.02). In only 23% of cases was PN required for severely ill patients. Our results suggest that EN might be considered to be an option for nutritional support in children undergoing MAC allo-SCT, while PN should be used only as a rescue option, possibly in combination with EN.

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Section: Discussionmentioning

confidence: 99%

Enteral nutrition: a first option for nutritional support of children following allo-SCT?

Azarnoush

Bruno

Béghin

et al. 2012

Bone Marrow Transplant

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“…3 To this end, Paneth cells produce and secrete cytoplasmic granules containing a battery of antimicrobial proteins. 26 Because enteral starvation and the use of total parenteral nutrition result in bacterial translocation in critically ill patients, 10 we hypothesized that the absence of oral food intake compromises Paneth cell functionality and its role in gut protection. Our results, which demonstrate morphological abnormalities in Paneth cells and a defect in Paneth cell antimicrobial protein production, support this hypothesis.…”

Section: Starvation Compromises Paneth Cells 2889mentioning

confidence: 99%

“…4 Enteral starvation and total parenteral nutrition, as applied to critically ill patients, are reported to result in increased gut wall permeability, a compromised immune system, and bacterial translocation. [5][6][7][8][9][10] Because autophagy, a process induced on starvation, [11][12][13] influences the generation of Paneth cell granules, 14 we hypothesize that enteral starvation impairs Paneth cell function, contributing to starvation-associated gut compromise.…”

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confidence: 99%

Starvation Compromises Paneth Cells

Hodin

Lenaerts

Grootjans

et al. 2011

The American Journal of Pathology

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The intestine is challenged with the task of protecting the body's internal milieu against bacterial invasion. To this end, the gut is equipped with an epithelial lining connected by tight junctions, a mucus layer, gut-associated lymphoid tissue, and Paneth cells. Paneth cells are highly specialized epithelial cells located in the crypts of the small intestine, and play an important role in gut innate immunity. 1 These cells sense bacterial presence and secrete granules containing antimicrobial peptides, including lysozyme, RegIII␥, and cryptdins (the murine counterparts of human ␣-defensins) both constitutively and in response to activation by bacteria or their products. 2 Using a murine cell ablation model, Paneth cells were shown to be crucial in host protection against invasion of both commensal and pathogenic microbiota. 3 In addition, our group has recently shown the additive importance of Paneth cells in preventing bacterial translocation in situations of physical intestinal barrier loss. 4 Enteral starvation and total parenteral nutrition, as applied to critically ill patients, are reported to result in increased gut wall permeability, a compromised immune system, and bacterial translocation. 5-10 Because autophagy, a process induced on starvation, 11-13 influences the generation of Paneth cell granules, 14 we hypothesize that enteral starvation impairs Paneth cell function, contributing to starvation-associated gut compromise.In this study, the effects of food deprivation on Paneth cell function were investigated using a mouse starvation model. We provide evidence that lack of enteral feeding results in Paneth cell autophagy, decreased expression of antimicrobial products (ie, lysozyme, cryptdin, and RegIII␥), and the presence of atypical secretory granules. Our results propose compromised Paneth cells to be involved in the reduced protection against bacterial translocation in enteral starvation.

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“…11,13-16 BT has been studied or described in humans in many varied clinical scenarios such as laparotomy, 17,18 emergency and elective surgery, [17][18][19][20] hematologic and colorectal malignancies, 21,22 intestinal obstruction, 23,24 burns, 25 inflammatory bowel disease, 26,27 aortic aneurysm repair, 28 liver resection, 29,30 obstructive jaundice, 31,32 trauma, [33][34][35] pediatric small bowel transplant, 36 and surgical neonates and infants receiving PN, 37 among others. Several of these studies also related BT to increased morbidity, [17][18][19]21,[23][24][25][26]28,29,31,33,34,37 but others did not. 20,22,27,30,32,35,36 A commonly proposed promotional mechanism of BT is physical damage to the barrier function of the intestinal mucosa leading to increased permeability.…”

Section: Discussionmentioning

confidence: 99%

An Occurrence of Sepsis During Inpatient Fecal Disimpaction

Darrow

Devito

2014

Pediatrics

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Functional constipation is a common pediatric problem that is often treated through well-established algorithms. Fecal disimpaction is the initial therapeutic step, and severe cases require hospitalization for intensive therapies. We describe a significant unexpected complication of this common clinical situation. An 8-year-old boy with suspected chronic functional constipation was hospitalized for disimpaction by continuous nasogastric administration of polyethylene glycol electrolyte (PEG-E) solution. On the sixth day of disimpaction, the patient abruptly developed fever, tachycardia, and tachypnea. Evaluation included blood culture, which grew Escherichia coli, and treatment with a course of appropriate antibiotics was provided. The safety of PEG-E solutions has been shown in studies of children with constipation, which made this patient’s illness surprising. Several potential etiologies of his infection were considered, including bacterial translocation (BT). BT is defined as the passage of live microbes and microbial products from the gastrointestinal tract to extraintestinal sites, such as the bloodstream. It has been shown to occur in a variety of clinical conditions but is of unclear clinical significance. In this case, physical damage to the intestinal mucosa was thought to contribute to the potential occurrence of BT, and prolonged disimpaction was considered as a risk factor. E coli sepsis in a child undergoing inpatient nasogastric fecal disimpaction with PEG-E represents a clinical problem never before reported in the literature and should increase clinicians’ indices of suspicion for uncommon complications of common procedures.

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Bacterial translocation studied in 927 patients over 13 years

Abstract: BT is associated with postoperative sepsis. Emergency surgery and TPN are independently associated with an increased prevalence of BT.

Cited by 175 publications

References 27 publications

Enteral nutrition: a first option for nutritional support of children following allo-SCT?

Enteral nutrition: a first option for nutritional support of children following allo-SCT?

Starvation Compromises Paneth Cells

An Occurrence of Sepsis During Inpatient Fecal Disimpaction

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