The DOI matches its Crossref record; 36 of the 36 references it cites were found in a registry or an index.
The Microbiology of Multiple Organ Failure: The Proximal Gastrointestinal Tract as an Occult Reservoir of Pathogens
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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In the citing paper
“The stomach and proximal small intestine, which are usually sparsely populated, become overgrown by a small number of species, such as E coli, P aeruginosa, and Enterococcus spp.”
From The microbiome and critical illness (2016) · cites this paper as [67]
In the citing paper
“The upper gastrointestinal tract becomes a stagnant reservoir of potential pathogens, the presence of which is predictive of extra-abdominal infections and multiorgan failure.”
From The microbiome and critical illness (2016) · cites this paper as [67]
In the citing paper
“the overgrown microbial reservoir of the stomach and small intestine becomes the primary source community for the mouth and lungs.”
From The microbiome and critical illness (2016) · cites this paper as [67]
Citations
Cites
Baker, S. P., O’Neill, B., Haddon, W. F., & Long, W. B. (1974) · PubMed · Cited by 7,946
APACHE—acute physiology and chronic health evaluation: a physiologically based classification system
Knaus, W. A., Zimmerman, J. E., Wagner, D. P., Draper, E. A., & Lawrence, D. E. (1981) · Critical Care Medicine · doi:10.1097/00003246-198108000-00008 · Cited by 2,190
Cachectin: More Than a Tumor Necrosis Factor
Epstein, F. H., Beutler, B., & Cerami, A. (1987) · New England Journal of Medicine · doi:10.1056/nejm198702123160705 · Cited by 1,423
McCabe, W. R. (1962) · Archives of Internal Medicine · doi:10.1001/archinte.1962.03620240029006 · Cited by 1,378
Fry, D. E. (1980) · Archives of Surgery · doi:10.1001/archsurg.1980.01380020006003 · Cited by 740
Stoutenbeek, C. P., SAENE, H. K. F. V., Miranda, D. R., & Zandstra, D. F. (1984) · Intensive Care Medicine · doi:10.1007/bf00259435 · Cited by 711
Lehmann, V., Freudenberg, M. A., & Galanos, C. (1987) · The Journal of Experimental Medicine · doi:10.1084/jem.165.3.657 · Cited by 547
Multiple Organ Failure in Polytrauma Patients
Faist, E., Baue, A. E., Dittmer, H., & Heberer, G. (1983) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/00005373-198309000-00002 · Cited by 494
Multiple, Progressive, or Sequential Systems Failure
Baue, A. E. (1975) · Archives of Surgery · doi:10.1001/archsurg.1975.01360130011001 · Cited by 481
DUMOULIN, G. (1982) · The Lancet · doi:10.1016/s0140-6736(82)90974-6 · Cited by 468
Patterns Of Septic Shock In Man—a Detailed Study Of 56 Patients
MacLean, L. D., Mulligan, W. G., McLean, A. P. H., & Duff, J. H. (1967) · Annals of Surgery · doi:10.1097/00000658-196710000-00004 · Cited by 384
FUNGÆMIA AND FUNGURIA AFTER ORAL ADMINISTRATION OF CANDIDA ALBICANS
Kŕause, W., Matheis, H., & Wulf, K. (1969) · The Lancet · doi:10.1016/s0140-6736(69)91534-7 · Cited by 351
Respiratory failure, hypotension, sepsis, and jaundice
Skillman, J. J., Bushnell, L. S., Goldman, H., & Silen, W. (1969) · The American Journal of Surgery · doi:10.1016/0002-9610(69)90011-7 · Cited by 284
Determinants of Organ Malfunction or Death in Patients With Intra-abdominal Sepsis
Pine, R. W. (1983) · Archives of Surgery · doi:10.1001/archsurg.1983.01390020084014 · Cited by 214
Remote organ failure: a valid sign of occult intra-abdominal infection.
Hc, P., & Cl, S. (1977) · PubMed · Cited by 206
The role of Candida in intraperitoneal infections.
Solomkin, J. S., Flohr, A. B., Quie, P. G., & Simmons, R. L. (1980) · PubMed · Cited by 195
McCabe, W. R. (1973) · Disease-a-Month · doi:10.1016/s0011-5029(73)80016-1 · Cited by 190
Enterococcal Bacteremia Clinical Implications and Determinants of Death
Garrison, R. N., FRY, D. E., Berberich, S., & Polk, H. C. (1982) · Annals of Surgery · doi:10.1097/00000658-198207000-00010 · Cited by 166
The Changing Pattern of Life-Threatening Microbial Disease
Rogers, D. E. (1959) · New England Journal of Medicine · doi:10.1056/nejm195910012611401 · Cited by 159
The Bacteriology of Intra-abdominal Infections
Lorber, B., & Swenson, R. M. (1975) · Surgical Clinics of North America · doi:10.1016/s0039-6109(16)40792-9 · Cited by 156
Wiles, J. B., Cerra, F. B., Siegel, J. H., & Border, J. R. (1980) · Critical Care Medicine · doi:10.1097/00003246-198002000-00001 · Cited by 151
Colonization of the gastric contents in critically patients
Hillman, K., Riordan, T., O’Farrell, S., & Tabaqchali, S. (1982) · Critical Care Medicine · doi:10.1097/00003246-198207000-00005 · Cited by 148
Both Inflammatory and Endocrine Mediators Stimulate Host Responses to Sepsis
Watters, J. M. (1986) · Archives of Surgery · doi:10.1001/archsurg.1986.01400020065008 · Cited by 144
Infection Prevention During Profound Granulocytopenia
Schimpff, S. C. (1980) · Annals of Internal Medicine · doi:10.7326/0003-4819-93-2-358 · Cited by 127
Does drainage of intraabdominal pus reverse multiple organ failure?
Norton, L. W. (1985) · The American Journal of Surgery · doi:10.1016/s0002-9610(85)80105-7 · Cited by 118
Intestinal Bacteria Translocate Into Experimental Intra-abdominal Abscesses
Wells, C. L. (1986) · Archives of Surgery · doi:10.1001/archsurg.1986.01400010116016 · Cited by 114
The Surgical Intensive Care Unit: Current Concepts in Infection
Meakins, J. L., Wicklund, B. M., Forse, R. A., & McLean, A. P. H. (1980) · Surgical Clinics of North America · doi:10.1016/s0039-6109(16)42038-4 · Cited by 104
The cause of post-traumatic pulmonary insufficiency in man.
Rl, F., & Ce, J. (1975) · PubMed · Cited by 89
Staphylococcus epidermidis: an important pathogen.
Forse, R. A., Dixon, C., Bernard, K., Martínez, L. F., McLean, A. P., & Jl, M. (1979) · PubMed · Cited by 87
Rotstein, O. D., Pruett, T., & Simmons, R. L. (1986) · PubMed · Cited by 79
The prevention of superinfection in multiple trauma patients
Stoutenbeek, C. P., van Saene, H. K. F., Miranda, D. R., Zandstra, D. F., & Binnendijk, B. (1984) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/14.suppl_b.203 · Cited by 69
Kupffer Cell Modulation of the Systemic Immune Response
Marshall, J. C. (1987) · Archives of Surgery · doi:10.1001/archsurg.1987.01400140073009 · Cited by 59
Prevention of Multiple Systems Failure
Baue, A. E., & Chaudry, I. H. (1980) · Surgical Clinics of North America · doi:10.1016/s0039-6109(16)42240-1 · Cited by 53
Physiology and Metabolism in Isolated Viral Septicemia
Deutschman, C. S. (1987) · Archives of Surgery · doi:10.1001/archsurg.1987.01400130027003 · Cited by 35
Newer Aspects of Septicemia in Surgical Patients
Altemeier, W. A. (1966) · Archives of Surgery · doi:10.1001/archsurg.1966.01320220122020 · Cited by 28
Christou, N. V., Boisvert, G., Broadhead, M., & Meakins, J. L. (1985) · World Journal of Surgery · doi:10.1007/bf01655198 · Cited by 18
Cited by
Sorted by citations
Bone, R. C., BALK, R. A., Cerra, F. B., Dellinger, R. P., Fein, A. M., Knaus, W. A., Schein, R. M. H., & Sibbald, W. J. (1992) · CHEST Journal · doi:10.1378/chest.101.6.1644 · Cited by 13,335
Multiple Organ Dysfunction Score
Marshall, J. C., Cook, D. J., Christou, N. V., Bernard, G. R., Sprung, C. L., & Sibbald, W. J. (1995) · Critical Care Medicine · doi:10.1097/00003246-199510000-00007 · Cited by 2,539
Moore, F. A., Feliciano, D. V., Andrassy, R. J., McArdle, A. H., Booth, F. V. M., MORGENSTEIN-WAGNER, T. B., Kellum, J. M., Welling, R. E., & Moore, E. E. (1992) · Annals of Surgery · doi:10.1097/00000658-199208000-00008 · Cited by 1,374
Gastric intramucosal pH as a therapeutic index of tissue oxygenation in critically ill patients
Gutiérrez, G., Pálizas, F., Doglio, G. R., Pusajo, J. F., Wainsztein, N. A., Klein, F., Gallesio, A. O., Román, E. S., Pacin, J., Dorfman, B., et al. (1992) · The Lancet · doi:10.1016/0140-6736(92)90002-k · Cited by 840
Pathological bacterial translocation in liver cirrhosis
Wiest, R., Lawson, M. A., & Geuking, M. B. (2013) · Journal of Hepatology · doi:10.1016/j.jhep.2013.07.044 · Cited by 826
“In addition, proximal gut colonization has been associated with increased BT and septic morbidity in surgical intensive care patients [208,209], indicating that small intestinal bacterial overgrowth has the greatest potential for promoting BT.”
Background
Metadata
- 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)
- 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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