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
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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