Bacteremia as a consequence of bacterial translocation, a mechanic bowel obstruction complication
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Jul 15, 2016
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Abstract
Intestinal obstruction is the most common surgical emergency compromising the small bowel. As part of the medical treatment the use of empiric antibiotic therapy has been suggested considering the pathological finding of bacterial translocation caused by small bowel obstruction. Methods: A broad systematic search was performed in Medline, EMBASE and PubMed bibliographic databases using key words as bacterial translocation, intestinal obstruction, gut microflora and/or sepsis. Results: This literature review intends to explore the physiopathological importance of the bacterial translocation in patients with mechanical small bowel obstruction, to establish if the bacterial translocation is a cause of bacteremia and/or sepsis, and finally assess the utility of antibiotic therapy. Conclusion: The literature informs an increased risk of bacterial translocation (14-15.4%), and sepsis complications and/or bacteremia (45%), however the existant evidence is not conclusive regarding the use of antibiotics and more research is required in this field.
Keywords
Bowel obstruction, bacterial translocation, bacteremia, lymphatic system, Intestinal mucosa.obstruccion intestinal, traslocación bacteriana, bacteremia, sistema linfático, mucosa intestinal
References
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3. Joseph SP, Simonson M, Edwards C. 'Let's just wait one more day': impact of timing on surgical outcome in the treatment of adhesion-related small bowel obstruction. Am Surg. 2013;79 (2):175-9.
4. Choi HK, Chu KW, Law WL. Therapetuic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment. Annals of surgery. 2002;236:1-6.
5. García L, Mateos A, Acosta E, Rodríguez J. Importancia clínica de la traslocación bacteriana. Nutrición hospitalaria. 2007;22:51.
6. O’Boyle C, Mitchell CJ, Macfie J, Josnstone D, Sagar PM, Sedman PC. Microbiology of bacterial translocation in humans.Gut. 1998;42:29-35.
7. Shiomi H, Shimizu T, Endo Y, Murata S, Yoshimasa K. Relations among circulationg monocytes, dendritic cells, and bacterial translocation in patients with intestinal obstruction. World J Surery 2007;31:1806-12.
8. Woodcock NP, Robertson J, Morgan DR, Gregg KL. Bacterial translocaction and inmunohistochemical measurement o gut immune function. J Clin Pathol. 2001;54:619-23.
9. Caricilli AM, Castoldi A, Saraiva NO. Intestinal barrier: A gentlemens agreement between microbiota and immunity. World journal of gastrointestinal pathophysiology. 2014;5:18-32.
10. Jackson PG, Raiji MT. Evaluation and management of intestinal obstruction. Am Fam Physician. 2011;83:159-65.
11. Gautreaux M, Deitch EA, Berg RD. Bacterial translocation from the gastrointestinal tract to various segments of the mesenteric lymph node complex. Infection And Immunity 1994;62:2132-34.
12. Petrone P, Sarkisyan G, Fernandez M, Coloma E, Akopian G. Small intestinal bacterial overgrowth in patients with lower gastrointestinal symptoms and a history of previous abdominal surgery. Arch Surgery 2011; 146: 444-7.
13. Macfie J, O’Boyle C, Mitchell CJ, Buckley PM, Jonstone D, Sudworth P. Gut origin of sepsis: a prospective study investigating associations between bacterial translocation, gastric microflora and septic morbidity. Gut 1999; 45: 223-228.
14. Quera P, Quigley EM, Madrid AM. Sobrecrecimiento bacteriano intestinal. Rev Med Chile. 2005;133:1361-70.
15. Zielinski, M., Eiken, P., Bannon, M., Heller, S., Lohse, C., Huebner, M. and Sarr, M. (2010). Small Bowel Obstruction—Who Needs an Operation? A Multivariate Prediction Model. World J Surg, 34(5), pp.910-919.
16. Macfie J. Bacterial translocation in surgical patients. Ann R Coll Surg Eng. 1997;79:183-9.
17. Pijls K, Daisy MA, Jonkers E, Elamin E, Masclee AM. Intestinal epithelial barrier function in liver cirrhosis : an extensive review of the literature. Liver Int. 2013; 10:1111-1227.
18. Wigg, A. (2001). The role of small intestinal bacterial overgrowth, intestinal permeability, endotoxaemia, and tumour necrosis factor alpha in the pathogenesis of non-alcoholic steatohepatitis. Gut, 48(2), pp.206-211.
19. Cariello, R., Federico, A., Sapone, A., Tuccillo, C., Scialdone, V., Tiso, A., Miranda, A., Portincasa, P., Carbonara, V., Palasciano, G., Martorelli, L., Esposito, P., Cartenì, M., Del Vecchio Blanco, C. and Loguercio, C. (2010). Intestinal permeability in patients with chronic liver diseases: Its relationship with the aetiology and the entity of liver damage. Digestive and Liver Disease, 42(3), pp.200-204.
20. Cesaro, C., Tiso, A., Del Prete, A., Cariello, R., Tuccillo, C., Cotticelli, G., del Vecchio Blanco, C. and Loguercio, C. (2011). Gut microbiota and probiotics in chronic liver diseases. Digestive and Liver Disease, 43(6), pp.431-438.
21. Minemura, M. Gut microbiota and liver diseases. World Journal of Gastroenterology, (2015). 21(6), p.1691.
22. Parlesak, A., Schäfer, C., Schütz, T., Bode, J. and Bode, C. (2000). Increased intestinal permeability to macromolecules and endotoxemia in patients with chronic alcohol abuse in different stages of alcohol-induced liver disease. Journal of Hepatology, 32(5), pp.742-747.
23. Raybould, H. (2012). Gut microbiota, epithelial function and derangements in obesity. The Journal of Physiology, 590(3), pp.441-446.
24. Lam Y, Ha CW, Campbell CR, Mitchell J, Dinudom A, Oscarsson J. Increased gut permeability and microbiota change associate with mesenteric fat inflammation and metabolic dysfunction in diet-induced obesed mice. PLoS ONE. 2012,7:1-10.
25. Sandek A, Bauditz J, Swidsinski A, Buhner S, Weber-Eibel J, J Am Coll. Altered intestinal function in patients with chronic heart failure. Cardiol. 2007;50:1561-9.
26. Rogler, G. and Rosano, G. (2013). The heart and the gut. European Heart Journal, 35(7), pp.426-430.
27. Krishnan B, Babu S, Walker J, Walker AB, Pappachan JM. Gastrointestinal complications of diabetes mellitus. World J Diabetes 2013;4:51-63.
28. Anders HJ, Andersen K, Stecher B. The intestinal microbiota, a leaky gut, and abnormal immunity in kidney disease. Kidney Int. 2013;83:1010-6.
29. Dayton MT, Dempsey DT, Larson GM, Posner AR. New paradigms in the treatment of small bowel obstruction. Curr Probl Surg. 2012; 49:642-717.
30. Jackson P, Raiji M. Evaluation and management of intestinal obstruction. American Family Physician. 2011;83:159-65.
31. Sarraf-yazdi S, Shapiro ML. Small bowel obstruction: the eternal dilemma of when to intervene. Scand J Surg. 2010;99:78-80.
32. Kopacova M, Burnes J, Cyrany J,Kohoutova D, Forsti M. Small intestinal bacterial overgrowth syndrome. World J Gastroentorl. 2010;16:2987-90.
33. MacFie J, Reddy BS, Gatt M, Jain PK, Sowdi R, Mitchell CJ. Bacterial translocation studied in 927 patients over 13 years. Br J Surg. 2006;93:87-93.
34. Deitch, E., Bridges, W., Ma, J., Ma, L., Berg, R. and Specian, R. (1990). Obstructed intestine as a reservoir for systemic infection. The American Journal of Surgery, 159(4), pp.394-401.
35. Deitch EA. Simple intestinal obstruction causes bacterial translocation in man. Arch Surg 1989; 124: 699-701Jackson PG, Raiji MT. Evaluation and management of intestinal obstruction. Am Fam Physician. 2011;83:159-65.
36. Pitt S. C., Hunt S. R. Intestino Delgado. En: Klingensmith M. E., Aziz A., Fox A. C., Porembka M. R, editores. Manual Washington de Cirugía. St. Louis, Missouri: Lippincott Williams&Wilkins; 2012. p 250-251.
37. Zielinski MD, Bannon MP. Current management of small bowel obstruction. Adv Surg. 2011;45:1-29.
38. Scheider DM, King PD, Miedema PW. Ascites and secondary bacterial peritonitis associated with small bowel obstruction. Am J Gastroenterol. 1994; 89:1238-40.
39. Di Saverio, S., Coccolini, F., Galati, M., Smerieri, N., Biffl, W., Ansaloni, L., Tugnoli, G., Velmahos, G., Sartelli, M., Bendinelli, C., Fraga, G., Kelly, M., Moore, F., Mandalà, V., Mandalà, S., Masetti, M., Jovine, E., Pinna, A., Peitzman, A., Leppaniemi, A., Sugarbaker, P., Goor, H., Moore, E., Jeekel, J. and Catena, F. (2013). Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg, 8(1), p.42.
40. Sagar PM, Macfie J, Sedman P, May J, Mancey-Jones B, Johnstone D. Intestinal obstruction promotes gut translocation of bacteria. Dis Colon Retum. 1995;38:640-4.
41. Mullan CP, Siewert B, Eisenberg RL. Small bowel obstruction. American journal of roentgenology. 2012;198:105-117.
42. Coccolini, F., Ansaloni, L., Manfredi, R., Campanati, L., Poiasina, E., Bertoli, P., Capponi, M., Sartelli, M., Saverio, S., Cucchi, M., Lazzareschi, D., Pisano, M. and Catena, F. (2013). Peritoneal adhesion index (PAI): proposal of a score for the “ignored iceberg” of medicine and surgery. World J Emerg Surg, 8(1), p.6.
43. Levy MM, Fink MP, Marshall JC. SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31:530-538
44. Alexander J, Vijay A, Jordan P, Wittec M. Gastrointestinal Lymphatics in Health and Disease. Pathophysiology. 2010;17:315-335.
45. Rocha FG, Theman TA, Matros E, Ledbetter SM, Zinner MJ. Nonoperative management of patients with a diagnosis of high-grade small bowel obstruction by computed tomography. Arch Surge. 2009; 144:1000-4.
46. Brook I. The role of anaerobic bacteria in bacteremia. Anaerobe. June 2010; 16(3):183-189.
47. Galeev YM, Lishmanov YB, Grigorev EG, Popov MV, Aparcinn KA, Salato OV. Scinntigraphic visualization of bacterial translocation in experimental strangulated intestinal obstruction. Eur J Nucl Med Mol IImaginf. 2009;36(11):1822-8.
48. Zanoni FL, Benabou S, Greco KV, Moreno AC, Cruz JW, Filgueira FP, Martinez MB, Figueiredo LF, Silva MR, Sannomiya P. Mesenteric microcirculatory dysfunctions and translocation of indigenous bacteria in a rat model of strangulated small bowel obstruction.Clinics (Sao Paulo).2009;64(9):911-9.
49. Bilderback PA, Massman JD, Smith RK, La Selva D, Helton WS. Small Bowel Obstruction Is a Surgical Disease: Patients with Adhesive Small Bowel Obstruction Requiring Operation Have More Cost-Effective Care When Admitted to a Surgical Service. J Am Coll Surg. 2015;221(1):7-13.
50. Bauer J, Keeley B, Krieger B, Deliz J, Wallace K, Kruse D, Dallas K, Bornstein J, Chessin D, Gorfine S. Adhesive Small Bowel Obstruction: Early Operative versus Observational Management. Am Surg.2015;81(6):614-20.
2. McKenzie S., Evers B. M. Small intestine. In: Townsend Jr. Courtney M., MD, Beauchamp R. Daniel, MD, Ever B. Mark, MD, Mattox Kenneth L., MD. Sabiston Textbook of Surgery. The Biological Basis of Modern Surgical Practice. 19th ed. Sanders; 2012. p. 1238-1239.
3. Joseph SP, Simonson M, Edwards C. 'Let's just wait one more day': impact of timing on surgical outcome in the treatment of adhesion-related small bowel obstruction. Am Surg. 2013;79 (2):175-9.
4. Choi HK, Chu KW, Law WL. Therapetuic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment. Annals of surgery. 2002;236:1-6.
5. García L, Mateos A, Acosta E, Rodríguez J. Importancia clínica de la traslocación bacteriana. Nutrición hospitalaria. 2007;22:51.
6. O’Boyle C, Mitchell CJ, Macfie J, Josnstone D, Sagar PM, Sedman PC. Microbiology of bacterial translocation in humans.Gut. 1998;42:29-35.
7. Shiomi H, Shimizu T, Endo Y, Murata S, Yoshimasa K. Relations among circulationg monocytes, dendritic cells, and bacterial translocation in patients with intestinal obstruction. World J Surery 2007;31:1806-12.
8. Woodcock NP, Robertson J, Morgan DR, Gregg KL. Bacterial translocaction and inmunohistochemical measurement o gut immune function. J Clin Pathol. 2001;54:619-23.
9. Caricilli AM, Castoldi A, Saraiva NO. Intestinal barrier: A gentlemens agreement between microbiota and immunity. World journal of gastrointestinal pathophysiology. 2014;5:18-32.
10. Jackson PG, Raiji MT. Evaluation and management of intestinal obstruction. Am Fam Physician. 2011;83:159-65.
11. Gautreaux M, Deitch EA, Berg RD. Bacterial translocation from the gastrointestinal tract to various segments of the mesenteric lymph node complex. Infection And Immunity 1994;62:2132-34.
12. Petrone P, Sarkisyan G, Fernandez M, Coloma E, Akopian G. Small intestinal bacterial overgrowth in patients with lower gastrointestinal symptoms and a history of previous abdominal surgery. Arch Surgery 2011; 146: 444-7.
13. Macfie J, O’Boyle C, Mitchell CJ, Buckley PM, Jonstone D, Sudworth P. Gut origin of sepsis: a prospective study investigating associations between bacterial translocation, gastric microflora and septic morbidity. Gut 1999; 45: 223-228.
14. Quera P, Quigley EM, Madrid AM. Sobrecrecimiento bacteriano intestinal. Rev Med Chile. 2005;133:1361-70.
15. Zielinski, M., Eiken, P., Bannon, M., Heller, S., Lohse, C., Huebner, M. and Sarr, M. (2010). Small Bowel Obstruction—Who Needs an Operation? A Multivariate Prediction Model. World J Surg, 34(5), pp.910-919.
16. Macfie J. Bacterial translocation in surgical patients. Ann R Coll Surg Eng. 1997;79:183-9.
17. Pijls K, Daisy MA, Jonkers E, Elamin E, Masclee AM. Intestinal epithelial barrier function in liver cirrhosis : an extensive review of the literature. Liver Int. 2013; 10:1111-1227.
18. Wigg, A. (2001). The role of small intestinal bacterial overgrowth, intestinal permeability, endotoxaemia, and tumour necrosis factor alpha in the pathogenesis of non-alcoholic steatohepatitis. Gut, 48(2), pp.206-211.
19. Cariello, R., Federico, A., Sapone, A., Tuccillo, C., Scialdone, V., Tiso, A., Miranda, A., Portincasa, P., Carbonara, V., Palasciano, G., Martorelli, L., Esposito, P., Cartenì, M., Del Vecchio Blanco, C. and Loguercio, C. (2010). Intestinal permeability in patients with chronic liver diseases: Its relationship with the aetiology and the entity of liver damage. Digestive and Liver Disease, 42(3), pp.200-204.
20. Cesaro, C., Tiso, A., Del Prete, A., Cariello, R., Tuccillo, C., Cotticelli, G., del Vecchio Blanco, C. and Loguercio, C. (2011). Gut microbiota and probiotics in chronic liver diseases. Digestive and Liver Disease, 43(6), pp.431-438.
21. Minemura, M. Gut microbiota and liver diseases. World Journal of Gastroenterology, (2015). 21(6), p.1691.
22. Parlesak, A., Schäfer, C., Schütz, T., Bode, J. and Bode, C. (2000). Increased intestinal permeability to macromolecules and endotoxemia in patients with chronic alcohol abuse in different stages of alcohol-induced liver disease. Journal of Hepatology, 32(5), pp.742-747.
23. Raybould, H. (2012). Gut microbiota, epithelial function and derangements in obesity. The Journal of Physiology, 590(3), pp.441-446.
24. Lam Y, Ha CW, Campbell CR, Mitchell J, Dinudom A, Oscarsson J. Increased gut permeability and microbiota change associate with mesenteric fat inflammation and metabolic dysfunction in diet-induced obesed mice. PLoS ONE. 2012,7:1-10.
25. Sandek A, Bauditz J, Swidsinski A, Buhner S, Weber-Eibel J, J Am Coll. Altered intestinal function in patients with chronic heart failure. Cardiol. 2007;50:1561-9.
26. Rogler, G. and Rosano, G. (2013). The heart and the gut. European Heart Journal, 35(7), pp.426-430.
27. Krishnan B, Babu S, Walker J, Walker AB, Pappachan JM. Gastrointestinal complications of diabetes mellitus. World J Diabetes 2013;4:51-63.
28. Anders HJ, Andersen K, Stecher B. The intestinal microbiota, a leaky gut, and abnormal immunity in kidney disease. Kidney Int. 2013;83:1010-6.
29. Dayton MT, Dempsey DT, Larson GM, Posner AR. New paradigms in the treatment of small bowel obstruction. Curr Probl Surg. 2012; 49:642-717.
30. Jackson P, Raiji M. Evaluation and management of intestinal obstruction. American Family Physician. 2011;83:159-65.
31. Sarraf-yazdi S, Shapiro ML. Small bowel obstruction: the eternal dilemma of when to intervene. Scand J Surg. 2010;99:78-80.
32. Kopacova M, Burnes J, Cyrany J,Kohoutova D, Forsti M. Small intestinal bacterial overgrowth syndrome. World J Gastroentorl. 2010;16:2987-90.
33. MacFie J, Reddy BS, Gatt M, Jain PK, Sowdi R, Mitchell CJ. Bacterial translocation studied in 927 patients over 13 years. Br J Surg. 2006;93:87-93.
34. Deitch, E., Bridges, W., Ma, J., Ma, L., Berg, R. and Specian, R. (1990). Obstructed intestine as a reservoir for systemic infection. The American Journal of Surgery, 159(4), pp.394-401.
35. Deitch EA. Simple intestinal obstruction causes bacterial translocation in man. Arch Surg 1989; 124: 699-701Jackson PG, Raiji MT. Evaluation and management of intestinal obstruction. Am Fam Physician. 2011;83:159-65.
36. Pitt S. C., Hunt S. R. Intestino Delgado. En: Klingensmith M. E., Aziz A., Fox A. C., Porembka M. R, editores. Manual Washington de Cirugía. St. Louis, Missouri: Lippincott Williams&Wilkins; 2012. p 250-251.
37. Zielinski MD, Bannon MP. Current management of small bowel obstruction. Adv Surg. 2011;45:1-29.
38. Scheider DM, King PD, Miedema PW. Ascites and secondary bacterial peritonitis associated with small bowel obstruction. Am J Gastroenterol. 1994; 89:1238-40.
39. Di Saverio, S., Coccolini, F., Galati, M., Smerieri, N., Biffl, W., Ansaloni, L., Tugnoli, G., Velmahos, G., Sartelli, M., Bendinelli, C., Fraga, G., Kelly, M., Moore, F., Mandalà, V., Mandalà, S., Masetti, M., Jovine, E., Pinna, A., Peitzman, A., Leppaniemi, A., Sugarbaker, P., Goor, H., Moore, E., Jeekel, J. and Catena, F. (2013). Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg, 8(1), p.42.
40. Sagar PM, Macfie J, Sedman P, May J, Mancey-Jones B, Johnstone D. Intestinal obstruction promotes gut translocation of bacteria. Dis Colon Retum. 1995;38:640-4.
41. Mullan CP, Siewert B, Eisenberg RL. Small bowel obstruction. American journal of roentgenology. 2012;198:105-117.
42. Coccolini, F., Ansaloni, L., Manfredi, R., Campanati, L., Poiasina, E., Bertoli, P., Capponi, M., Sartelli, M., Saverio, S., Cucchi, M., Lazzareschi, D., Pisano, M. and Catena, F. (2013). Peritoneal adhesion index (PAI): proposal of a score for the “ignored iceberg” of medicine and surgery. World J Emerg Surg, 8(1), p.6.
43. Levy MM, Fink MP, Marshall JC. SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31:530-538
44. Alexander J, Vijay A, Jordan P, Wittec M. Gastrointestinal Lymphatics in Health and Disease. Pathophysiology. 2010;17:315-335.
45. Rocha FG, Theman TA, Matros E, Ledbetter SM, Zinner MJ. Nonoperative management of patients with a diagnosis of high-grade small bowel obstruction by computed tomography. Arch Surge. 2009; 144:1000-4.
46. Brook I. The role of anaerobic bacteria in bacteremia. Anaerobe. June 2010; 16(3):183-189.
47. Galeev YM, Lishmanov YB, Grigorev EG, Popov MV, Aparcinn KA, Salato OV. Scinntigraphic visualization of bacterial translocation in experimental strangulated intestinal obstruction. Eur J Nucl Med Mol IImaginf. 2009;36(11):1822-8.
48. Zanoni FL, Benabou S, Greco KV, Moreno AC, Cruz JW, Filgueira FP, Martinez MB, Figueiredo LF, Silva MR, Sannomiya P. Mesenteric microcirculatory dysfunctions and translocation of indigenous bacteria in a rat model of strangulated small bowel obstruction.Clinics (Sao Paulo).2009;64(9):911-9.
49. Bilderback PA, Massman JD, Smith RK, La Selva D, Helton WS. Small Bowel Obstruction Is a Surgical Disease: Patients with Adhesive Small Bowel Obstruction Requiring Operation Have More Cost-Effective Care When Admitted to a Surgical Service. J Am Coll Surg. 2015;221(1):7-13.
50. Bauer J, Keeley B, Krieger B, Deliz J, Wallace K, Kruse D, Dallas K, Bornstein J, Chessin D, Gorfine S. Adhesive Small Bowel Obstruction: Early Operative versus Observational Management. Am Surg.2015;81(6):614-20.
How to Cite
Chavarriaga Soto, J. Ánd´res. (2016). Bacteremia as a consequence of bacterial translocation, a mechanic bowel obstruction complication. Universitas Medica, 57(2). https://doi.org/10.11144/Javeriana.umed57-2.bstb
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