Cited by 328Nosocomial Infections in ICUSepsis Diagnosis and TreatmentAntifungal resistance and susceptibility

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The Microbiology of Multiple Organ Failure: The Proximal Gastrointestinal Tract as an Occult Reservoir of Pathogens

Marshall, John C.·1988·Archives of Surgery

DOI 10.1001/archsurg.1988.01400270043006

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Abstract

The microbiology of infection acquired in the intensive care unit (ICU) was studied prospectively in 205 consecutive patients admitted to a surgical intensive care unit. A multiple organ failure (MOF) score was calculated for each admission. Susceptibility to ICU-acquired infection increased with increasing MOF scores. While Escherichia coli, Bacteroides fragilis, and enterococci were the most common isolates from infections present at the time of ICU admission, Staphylococcus epidermidis, Candida, and Pseudomonas dominated infections occurring in patients with high MOF scores. Mortality correlated highly with infection due to S epidermidis or Candida and only poorly with infection due to Pseudomonas or E coli; significant foci of invasive infection were frequently absent at autopsy. Quantitative cultures of proximal gastrointestinal fluid in 16 of these patients showed Candida, S epidermidis, and Pseudomonas to be the most common isolates, and all but one patient colonized with these organisms had invasive infection with the same organism. The proximal gastrointestinal tract appears to be an important occult reservoir of the predominant pathogens in MOF.

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Authors: Marshall, J. C.
Affiliations: Royal Victoria Hospital (CA)
Corresponding author: Marshall, John C.
Venue: Archives of Surgery
Publisher: American Medical Association (AMA)
Published: 1988-03-01
Volume: 123
Issue: 3
Pages: 309
ISSN: 0004-0010 (ISSN-L)
DOI: 10.1001/archsurg.1988.01400270043006
OpenAlex: W1964088213
Cited by: 328
References: 36
Citations by year: 2026: 3 · 2025: 2 · 2024: 3 · 2022: 1 · 2021: 4 · 2020: 3 · 2019: 2 · 2018: 4 · 2017: 3 · 2016: 3 · 2015: 2 · 2014: 4 · 2013: 3 · 2012: 6
FWCI: 16.54
Type: journal article
Language: en
Open access: closed
Locations: Archives of Surgery (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Keywords: multiple organ failure, intensive care unit-acquired infections, surgical intensive care unit, Escherichia coli, Bacteroides fragilis, Enterococcus, Staphylococcus epidermidis, Candida, Pseudomonas, mortality, intestinal colonization, autopsy findings
MeSH terms: Bacteroides fragilis, Candida, Cross Infection, Digestive System, Duodenum, Gastric Juice, Humans, Infections, Intensive Care Units, Middle Aged, Multiple Organ Failure, Prospective Studies, Pseudomonas, Staphylococcus epidermidis

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The Microbiology of Multiple Organ Failure: The Proximal Gastrointestinal Tract as an Occult Reservoir of Pathogens

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