Intraabdominal infections and gut origin sepsis

Abstract

Intraabdominal postoperative or posttraumatic infections remain a major threat to life in spite of generation after generation of increasingly effective antimicrobial drugs indicating the importance of immunological host defense failure following major trauma or surgical complications. The spectrum of infectious postoperative or posttraumatic complications can, in part, be explained by pathogenic factors inherent to the methodology of modern surgical intensive care and techniques. This report presents a survey of the historical background as well as current concepts of the multiple systems organ failure syndrome as related to postoperative or posttraumatic intraabdominal infectious complications. The pathophysiology of nosocomial infectious complications in the intensive care unit setting is analyzed. The concept of "gut origin sepsis" is presented and possible preventive and therapeutic actions discussed. A judicious use of antimicrobial drugs on strict indications is emphasized as is the importance of increased knowledge of the interactions between the gut flora, antibiotics, and absence of enteral nutrition.

Comparison of the Effects of Different Strains of <i>Lactobacillusin</i> Reducing Bacterial Translocation on Methotrexate-lnduced Enterocolitis in Rats

“…In this study, we showed that the three strains of Lactobacillus reversed the disrupted microflora, both in the ileum and cecum, as indi cated by a decrease in overall bacterial populations, which were elevated following the administration of an elemental diet and MTX [10,12,32,33], The decrease in bacterial number in the present study was most prominent in Emerobacteriaceae and gram-negative anaerobes, which are considered to be potentially pathogenic bacteria frequently isolated from infected sites in patients with postoperative intra-abdominal septic complications [34,35]. Furthermore, oral administration oflactobacilli in this study increased the intestinal population oflactobacilli in the ileum and colon, which coincided with other findings [14,17], It is known that lactobacilli can re-establish the normal host intestinal microfiora [3,36], inhibit and con trol potential intestinal pathogens [37], These effects can be caused by competition for adhesion sites and nutrients between the ingested lactobacilli and the potential patho gens [6], Moreover, lactobacilli produce acidic and other metabolic end products such as hydrogen peroxide and diacetyl, as well as a variety of antibiotic-like substances, which have strong inhibitory effects on the growth of pathogenic microbes [25.38].…”

Source Control bei abdomineller Infektion

“…Eine kausale, auf der Pathophysiologie des septischen Schocks basierende Therapie ist hierbei nur eingeschränkt möglich [15,16]. Maßnahmen zur Verstärkung der Mukosabarriere, selektive Darmdekontamination oder orthograde Spülung und Anlage eines Ileostomas werden therapieunterstüt-zend eingesetzt [17]. Eine Verbesserung der bisherigen therapeutischen Vorgehensweise kann nur unter Einbeziehung pathogenetischer Aspekte in neue Therapiestrategien (z.…”

Increased Bacterial Translocation and Impaired Immune Response after Transfusion of Allogeneic Leukocytes

“…In fact, it could be, at least in part, a predisposing factor for systemic infections [1,2], postin jury hypermetabolism [20,21], multiple system organ failure in critically ill patients [22] and clinical sepsis syn drome in the absence of a defined focus of infection [23,24], The role of the immune system in the clearance of translocated bacteria is a crucial aspect in the occurrence of potential overwhelming infections. Once, the microor ganisms have crossed the gut barrier, they can be either cleared by the immune defenses or trigger a septic compli cation.…”