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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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Metabolic Endotoxemia Initiates Obesity and Insulin Resistance
Cani, P. D., Amar, J., Iglesias, M. A., Poggi, M., Knauf, C., Bastelica, D., Neyrinck, A. M., Fava, F., Tuohy, K. M., Chabo, C., et al. (2007) · Diabetes · doi:10.2337/db06-1491 · Cited by 6,638
“Endogenous LPS is continually produced within the gut by the death of Gram-negative bacteria (27) and is absorbed into intestinal capillaries (28,29) to be transported by lipoproteins (14,15).”
BackgroundCirculating mitochondrial DAMPs cause inflammatory responses to injury
Zhang, Q., Raoof, M., Chen, Y., Sumi, Y., Sursal, T., Junger, W., Brohi, K., Itagaki, K., & Hauser, C. J. (2010) · Nature · doi:10.1038/nature08780 · Cited by 3,812
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
Self-citationMultiple Organ Failure Pathophysiology and Potential Future Therapy
Deitch, E. A. (1992) · Annals of Surgery · doi:10.1097/00000658-199208000-00002 · Cited by 1,378
Kudsk, K. A., Croce, M. A., Fabian, T. C., Minard, G., Tolley, E. A., PORET, H. A., KUHL, M. R., & Brown, R. O. (1992) · Annals of Surgery · doi:10.1097/00000658-199205000-00013 · Cited by 1,149
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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