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Gut Bacterial Translocation via the Portal Vein: A Clinical Perspective with Major Torso Trauma
Abstract
Animal studies implicate gut bacterial translocation via the portal vein as a major factor in the pathogenesis of postinjury multiple organ failure (MOF). We therefore inserted portal vein catheters for sequential blood sampling in the operating room, at 6, 12, 24, and 48 hours, and 5 days postoperatively in 20 injured patients (13 blunt, seven penetrating; mean age, 34 years) requiring emergent laparotomy and who were at known risk for MOF. The mean Revised Trauma Score was 6.4 +/- 0.4, and the Injury Severity Score, 29.3 +/- 2.3. Twelve (60%) patients arrived in shock (SBP less than 90 torr). Eight (2%) of 212 portal blood cultures were positive; seven were presumed contaminants. The only positive systemic culture (total, 212) was a Staphylococcus aureus on day 5 in a patient with a concurrent staphyloccal pneumonia. In the first 48 hours, we could not detect endotoxin in portal or systemic blood. Additionally, simultaneous portal and systemic blood levels of complement fragment C3a, tumor necrosis factor, and interleukin-6 were nearly identical and, specifically, were not different in those patients who developed MOF. In summary, this prospective clinical study has not confirmed portal or systemic bacteremia within the first 5 days postinjury, despite an eventual 30% incidence of MOF.
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“in a study of trauma patients at high risk of multiorgan failure,101 serial blood cultures drawn from indwelling portal vein catheters have shown minimum evidence of bacterial translocation and no association between portal vein bacteraemia and subsequent illness.”
From The microbiome and critical illness (2016) · cites this paper as [101]
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THE GUT'S ROLE IN METABOLISM, MUCOSAL BARRIER FUNCTION, AND GUT IMMUNOLOGY
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Self-citationDanger signals from mitochondrial DAMPS in trauma and post-injury sepsis
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ResultDeterminants of intestinal barrier failure in critical illness
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“The link between bacterial translocation and ARDS/MODS is less conclusive with bacteria and endotoxin being identified in the portal blood of only 2% of trauma patients who later went on to develop MODS.3 The suggestion that bacterial translocation and liberation of pro-inflammatory mediators may be independent of the…”
BackgroundPostinjury Shock and Early Bacteremia
Moore, F. A. (1992) · Archives of Surgery · doi:10.1001/archsurg.1992.01420080027004 · Cited by 68
Self-citationInflammatory mediators in intra-abdominal sepsis or injury – a scoping review
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BackgroundGut microbiota and environment in patients with major burns – A preliminary report
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“However, several studies, including the study by Moore et al, where neither bacteria nor endotoxin was found in the portal blood of severely injured trauma patients raised doubts about the clinical relevance of bacterial translocation.(25) Recently, new insights into the pathogenesis of gut-induced acute lung injury a…”
ResultCothren, C. C., Moore, E. E., Ciesla, D. J., et al. (2004) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2004.08.036 · Cited by 66
Self-citationMonti, P., Wysocki, J., der Meeren, A. V., & Griffiths, N. M. (2005) · British Journal of Radiology · doi:10.1259/bjr/53186341 · Cited by 66
“Conversely, other data exist demonstrating that the GIT does not have a major role in MOF, in particular with regard to bacterial translocation where clinical trials have failed to demonstrate endotoxin or bacteria in portal blood [9].”
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Self-citationInflammatory response to trauma
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“, IL-10 and sTNFR) might lead to immunparalysis and a late sepsis-induced MOF (18, 12).”
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“The importance of the gut as an “engine of inflammation” (8) was called into question by work showing that the portal bloodstream is not a source of inflammatory mediators in clinical trauma (9).”
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Thoracic Duct in Patients With Multiple Organ Failure: No Major Route of Bacterial Translocation
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The 2016 ESPEN Arvid Wretlind lecture: The gut in stress
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“Despite these explanations, preliminary metabolomics results were intriguing in that they provided an alternative rationale linking metabolites derived from the gut microbiome to post-T/HS sequelae without the need for actual bacterial translocation (consistent with controversial data on showing no direct marker of ba…”
ResultSelf-citationSepsis, Severe Sepsis, and Septic Shock
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“This is consistent with studies in critically ill patients, suggesting that translocation of intact bacteria occurs infrequently (22).”
ResultBacterial translocation: what it is and what it is not
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“In response to the many animal studies demonstrating bacterial translocation, Moore et al [6] performed one of the first large clinical investigations in a cohort of 20 abdominal trauma patients requiring laparotomy.”
BackgroundDisorders of the lymph circulation: their relevance to anaesthesia and intensive care
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Multiple Organ Dysfunction During Resuscitation Is Not Postinjury Multiple Organ Failure
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“The working definition of MOF that we developed previously did not include MOD scores obtained during the first 48 hours following injury because organ dysfunction during this period was thought to reflect the host response to injury and effects of incomplete resuscitation.(5) As a result, we were potentially ignoring…”
MethodNutritional Support and Infection: Does the Route Matter?
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Permissive Hypercapnia in Trauma Patients
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“The older explanation for gut-derived sepsis suggested bacteria entered the portal blood and caused downstream organ dysfunction; in trauma patients with a high risk for MODS, however, Moore demonstrated minimal evidence of portal vein bacteremia and no association between bacteremia and illness [14,15].”
BackgroundMultiple organ failure syndrome
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What's New in Burns and Metabolism
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BackgroundResultInfluentialMesenteric Lymph Is Responsible for Post-Hemorrhagic Shock Systemic Neutrophil Priming
Gonzalez, R. J., Moore, E. E., Ciesla, D. J., et al. (2001) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/00005373-200112000-00008 · Cited by 50
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“Evidence for BT associated with trauma in the clinical literature, however, argues against that found in the laboratory and continues to be an area of debate.(18-21) Several investigators(20-22) have found no association between trauma patients and MLN culture positivity.”
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Self-citationBeneficial Effect of Enteral Feeding
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“The Postinjury Multiple Organ Failure Score was used to assess the severity of multiple organ dysfunction syndrome after 48 hrs of intensive care stay (28).”
MethodArachidonic acid in postshock mesenteric lymph induces pulmonary synthesis of leukotriene B4
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“Although initial animal models offered supportive evidence (5, 29), clinical corroboration in the critically injured patient was lacking (21).”
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“However, translocation of endotoxin or bacteria have not been commonly found in patients after major trauma (Rush et al. 1988; Moore et al. 1991 ; Hoch et al. 1993; Roumen et al. 1993) or burns (Deitch, 19906).”
BackgroundInvolvement of Bacteria/Endotoxin Translocation in the Development of Multiple Organ Failure
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Monoclonal antibody to endotoxin attenuates hemorrhage-induced lung injury and mortality in rats
Bahrami, S., Yao, Y.-M., Leichtfried, G., Redl, H. R., Schlag, G., & Padova, F. E. D. (1997) · Critical Care Medicine · doi:10.1097/00003246-199706000-00021 · Cited by 41
Endotoxemia Following Multiple Trauma
Charbonney, E., Tsang, J. L. Y., Li, Y., Klein, D. J., Duque, P., Romaschin, A. D., & Marshall, J. C. (2015) · Critical Care Medicine · doi:10.1097/ccm.0000000000001404 · Cited by 40
“Whether multiple trauma results in endotoxemia remains controversial, with some authors reporting endotoxemia early following trauma (9), whereas others have failed to demonstrate endotoxin at any time in either portal venous or systemic blood (10).”
BackgroundResultSchreiber, V. M., Tarkin, I. S., Hildebrand, F., et al. (2010) · Injury · doi:10.1016/j.injury.2010.07.248 · Cited by 40
Yao, Y.-M., Lu, L.-R., Yu, Y. H., et al. (1997) · doi:10.1097/00005373-199706000-00015 · Cited by 40
Remote Intestinal Injury Early After Experimental Polytrauma and Hemorrhagic Shock
Wrba, L., Ohmann, J. J., Eisele, P., Chakraborty, S., Braumüller, S. T., Braun, C., Klohs, B., Schultze, A., von Baum, H., Palmer, A., et al. (2018) · Shock · doi:10.1097/shk.0000000000001271 · Cited by 39
“Unauthoriz was mainly shown in rodent models (18, 19), but not in human patients (20).”
BackgroundArtificial Nutrition and Intestinal Mucosal Barrier Functionality
Anastasilakis, C. D., Ioannidis, O., Gkiomisi, A. I., & Botsios, D. (2013) · Digestion · doi:10.1159/000353603 · Cited by 38
Prevalence and Identity of Translocating Bacteria in Healthy Dogs
Dahlinger, J., Marks, S. L., & Hirsh, D. C. (1997) · Journal of Veterinary Internal Medicine · doi:10.1111/j.1939-1676.1997.tb00473.x · Cited by 38
Elevated Serum Pancreatic Enzyme Levels After Hemorrhagic Shock Predict Organ Failure and Death
Malinoski, D., Hadjizacharia, P., Salim, A., et al. (2009) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0b013e3181b5dc11 · Cited by 38
Lawlor, D. K., Brock, R. W., Harris, K. A., & Potter, R. F. (1999) · Journal of Vascular Surgery · doi:10.1016/s0741-5214(99)70081-9 · Cited by 37
Infarcted intestine: a diagnostic void
Glenister, K., & Corke, C. F. (2004) · ANZ Journal of Surgery · doi:10.1111/j.1445-2197.2004.02956.x · Cited by 38
Caruso, J. M., Feketeova, E., Dayal, S. D., et al. (2003) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/01.ta.0000037410.85492.77 · Cited by 38
Artificial Nutrition: Principles and Practice of Enteral Feeding
Lloyd, D. A., & Powell-Tuck, J. (2004) · Clinics in Colon and Rectal Surgery · doi:10.1055/s-2004-828657 · Cited by 36
“Continued supply of nutrition to the gut is believed to help prevent mucosal atrophy,(5) decrease endotoxin translocation, and maintain gut barrier function, which may become compromised in patients receiving parenteral nutrition.(6,7) The relationship of parenteral feeding with intestinal bacterial translocation rema…”
Metadata
- Authors
- MOORE, F. A., MOORE, E. E., POGGETTI, R., McANENA, O. J., PETERSON, V. M., ABERNATHY, C. M., & PARSONS, P. E.
- Affiliations
- Denver Health Medical Center (US)
- ORCID
- MOORE, ERNEST E.
- Venue
- The Journal of Trauma: Injury, Infection, and Critical Care
- Published
- 1991-05
- Volume
- 31
- Issue
- 5
- Pages
- 629-638
- ISSN
- 0022-5282 (ISSN-L)
- OpenAlex
- W2053522978
- Cited by
- 491
- References
- 0
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 6 · 2023: 8 · 2022: 5 · 2021: 3 · 2020: 12 · 2019: 8 · 2018: 14 · 2017: 18 · 2016: 22 · 2015: 13 · 2014: 9 · 2013: 11 · 2012: 10
- FWCI
- 16.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Trauma: Injury, Infection, and Critical Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5p50hl040784-10)
- National Heart, Lung, and Blood Institute (P50 HL-40784-01, K08 HLO-1849-04)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Abdominal Trauma and Injuries
- Health Sciences › Medicine › Surgery › Abdominal Surgery and Complications
- Keywords
- gut bacterial translocation, portal vein, multiple organ failure, bacteremia, trauma (physical injury), endotoxin, complement C3a, TNF-α, interleukin-6, traumatic shock
- MeSH terms
- Abdominal Injuries, Adult, Bacteria, Endotoxins, Humans, Intestines, Multiple Organ Failure, Multiple Trauma, Portal Vein, Prospective Studies, Wounds, Nonpenetrating, Trauma Severity Indices, Interleukin-6, Fractures, Bone
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