Normal Bacterial Populations of the Intestine and Their Relation to Intestinal Function

Donaldson, Robert M.

doi:10.1056/nejm196404302701806

Cited by 186 publications

(48 citation statements)

References 66 publications

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“…This suggests that a situation similar to duodenal diverticulosis may occur after biliary fenestration. However, 3 patients with fenestration and 5 control subjects exhibited duodenal bacterial cultures of streptococci and staphylococci, as has been observed by Donaldson (1964) ~ Kalser, Cohen, Arteaga, Yawn, Mayoral, Hoffert, and Frazier (1966), Donaldson, McConnell, and Deffner (1967), Gorbach, Plaut, Nahas, and Weinstein (1967), and Drasar, Shiner, and McLeod (1969).…”

Section: Discussionsupporting

confidence: 52%

Bacterial flora in the duodenum of patients after biliary fenestration

Thomas

Grant

Holford

et al. 1973

Journal of British Surgery

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Section: Discussionsupporting

confidence: 52%

Bacterial flora in the duodenum of patients after biliary fenestration

Thomas

Grant

Holford

et al. 1973

Journal of British Surgery

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“…Most organisms cultured from ascites in patients with SBP (1) are part of the normal aerobic flora of the gut (10)(11)(12). Low concentrations (one organism per milliliter) of a single organism are typical (13).…”

mentioning

confidence: 99%

“…Sixty percent to 80% of the organisms in patients with SBP are aerobic gram-negative bacteria (1, 2, 5, 6, 11,[14][15][16][17]. Escherichia coli is associated with 40% to 50% of cases of SBP (1,2,5,6,14), perhaps reflecting the abundance in stool (9)(10)(11). However, more frequent extraascitic dissemination with E. coli is compatible with greater virulence (9,18,19).…”

mentioning

confidence: 99%

Spontaneous bacterial peritonitis: Prevention and therapy

Hoefs

1990

Hepatology

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Spontaneous bacterial peritonitis (SBP) is a serious problem in patients with cirrhotic ascites, with an incidence of 10% to 25% on hospital admission (1) and accounting for 5% to 30% of all infections in cirrhotic patients (2, 3), 19% of documented bacteremic episodes (4) and 60% to 75% of all "serious" infections (5, 6). Recent studies (1,7,8) have focused attention on culture techniques, diagnosis, differentiation from secondary peritonitis, pathogenesis and predisposing factors. However, data on prevention and therapy have been scarce. Gin& et al. in this issue of HEPATOLOGY report the first prospective trial of prevention of SBP by use of longterm antibiotic prophylaxis (9). Is this rational with our present knowledge of the pathogenesis and therapy of SBP?Most organisms cultured from ascites in patients with SBP (1) are part of the normal aerobic flora of the gut (10-12). Low concentrations (one organism per milliliter) of a single organism are typical (13). SBP with multiple organisms or anaerobes is distinctly uncommon and probably represents secondary bacterial peritonitis. Sixty percent to 80% of the organisms in patients with SBP are aerobic gram-negative bacteria (1, 2, 5, 6, 11, 14-17). Escherichia coli is associated with 40% to 50% of cases of SBP (1, 2, 5, 6, 14), perhaps reflecting the abundance in stool (9-11). However, more frequent extraascitic dissemination with E. coli is compatible with greater virulence (9, 18, 19). The remaining organisms causing SBP are gram-positive cocci; half of which are found in the gut (1). Thus the gut appears to be the repository of most organisms causing SBP.Multiple mechanisms potentially predispose to SBP. Studies of the microbial flora in cirrhotic patients show no significant qualitative or quantitative difference from normal individuals (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Thus an unusual spectrum or quantity of aerobic organisms or decreased colonization resistance by anaerobic bacteria does not appear to play a role. The decreased serum bactericidal and opsonic activity and abnormal polymorphonuclear cell function demonstrated in cirrhotic patients (31-34) have not been associated with SBP, and the degree of defect appears insufficient for such a role. Intrahepatic and extrahepatic shunting may predispose to SBP by increasing systemic bacteremia from the gut owing to Address reprint requests to:

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“…The reasons for neglect are partly historical in that emphasis has been placed on pathogenic microorganisms and partly technical in that many members of the normal flora are difficult to cultivate. The complex nature of the gastrointestinal flora is emphasized by the fact that more than 60 bacterial species have been isolated from the in-2022 testinal tracts or feces of healthy animals, including man (13). Many studies have dealt with the coliforms and enterococa and this reflects the ease with which these organisms can be cultivated.…”

mentioning

confidence: 99%