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Cited by 707Nosocomial Infections in ICUSepsis Diagnosis and TreatmentClinical Nutrition and Gastroenterology

The gastrointestinal tract. The “undrained abscess” of multiple organ failure

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Marshall, John C., Christou, Nicolas V., Meakins, Jonathan L.·1993·Annals of Surgery
DOI 10.1097/00000658-199308000-00001PMC PMC1242919
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Abstract

OBJECTIVE: This study determined the association between proximal gastrointestinal (GI) colonization and the development of intensive care unit (ICU)-acquired infection and multiple organ failure (MOF) in a population of critically ill surgical patients. SUMMARY BACKGROUND DATA: ICU-acquired infection in association with progressive organ system dysfunction is an important cause of morbidity and mortality in critical surgical illness. Oropharyngeal and gastric colonization with the characteristic infecting species is common, but its association with ICU morbidity is poorly defined. METHODS: A prospective cohort study of 41 surgical ICU patients was undertaken. Specimens of gastric and upper small bowel fluid were obtained for quantitative culture; the severity of organ dysfunction was quantitated by a numeric score. RESULTS: One or more episodes of ICU-acquired infection developed in 33 patients and involved at least one organism concomitantly cultured from the upper GI tract in all but 3. The most common organisms causing ICU-acquired infection--Candida, Streptococcus faecalis, Pseudomonas, and coagulase-negative Staphylococci--were also the most common species colonizing the proximal GI tract. Gut colonization correlated with the development of invasive infection within 1 week of culture for Pseudomonas (90% vs. 13% in noncolonized patients, p < 0.0001) or Staphylococcus epidermidis (80% vs. 6%, p < 0.0001); a weaker association was seen for colonization with Candida. Infections associated with GI colonization included pneumonia (16 patients), wound infection (12 patients), urinary tract infection (11 patients), recurrent (tertiary) peritonitis (11 patients), and bacteremia (10 patients). ICU mortality was greater for patients colonized with Pseudomonas (70% vs. 26%, p = 0.03); organ dysfunction was most marked in patients colonized with one or more of the following: Candida, Pseudomonas, or S. epidermidis. CONCLUSIONS: The upper GI tract is an important reservoir of the organisms causing ICU-acquired infection. Pathologic GI colonization is associated with the development of MOF in the critically ill surgical patient.

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  • The upper gastrointestinal tract becomes a stagnant reservoir of potential pathogens whose presence is predictive of extra-abdominal infections and multiorgan failure.

    “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 [64]

  • The dynamics of the aerodigestive tract become inverted during critical illness: the overgrown microbial reservoir of the stomach and small intestine becomes the primary source community for the mouth and lungs.

    “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 [64]

  • The net effect of altered elimination in critical illness is reduced elimination of bacteria, especially in the upper gastrointestinal tract, which becomes a pH-neutral reservoir overgrown by Gram-negative bacteria.

    “The net effect is reduced elimination of bacteria, especially in the upper gastrointestinal tract, which is transformed into a pH-neutral reservoir that quickly becomes overgrown by Gram-negative bacteria.”

    From The microbiome and critical illness (2016) · cites this paper as [64]

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Authors
Marshall, J. C., Christou, N. V., & Meakins, J. L.
Affiliations
  • University of Toronto (CA)
  • McGill University (CA)
Corresponding author
Marshall, John C.
Venue
Annals of Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1993-08
Volume
218
Issue
2
Pages
111-119
ISSN
0003-4932 (ISSN-L)
DOI
10.1097/00000658-199308000-00001
PMC
PMC1242919
OpenAlex
W2091326259
Cited by
707
References
49
Citations by year
2026: 2 · 2025: 12 · 2024: 4 · 2023: 7 · 2022: 11 · 2021: 12 · 2020: 10 · 2019: 7 · 2018: 5 · 2017: 14 · 2016: 12 · 2015: 9 · 2014: 17 · 2013: 12 · 2012: 10
FWCI
11.74
Type
journal article
Language
en
Open access
Locations
  • Annals of Surgery (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
Keywords
intestinal colonization, multiple organ failure, intensive care unit infections, critically ill surgical patients, Pseudomonas, Candida, Staphylococcus epidermidis, Enterococcus faecalis, peritonitis, bacteremia, pneumonia, wound infection, urinary tract infection, ICU mortality, upper gastrointestinal tract
MeSH terms
Aged, Bacterial Infections, Candida, Cross Infection, Digestive System, Female, Humans, Intensive Care Units, Male, Middle Aged, Multiple Organ Failure, Postoperative Period, Prospective Studies, Pseudomonas, Staphylococcus epidermidis, Incidence

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