Bacterial translocation

Deitch, E.A., Bridges, W., Baker, J., Ma, L., Grisham, M.B., Granger, D.N., Specian, R.D. and Berg, R. (1988). Haemorrhagic shock-induced bacterial translocation is reduced by xanthine oxidase inhibition or inactivation. Surgery 104, 191-198. 

Nieuwenhuijs VB, Verheem A, van Duijven-bode-Beumer H, Visser MR, Verhoef J, Gooszen HG, et al The role of interdigestive small bowel motility in the regulation of gut microflora, bacterial overgrowth, and bacterial translocation in rats. Ann Surg 1998,228 188-193. 

Bacterial translocation is defined as the passage of viable indigenous bacteria from the GI tract to extraintesti-nal sites, such as the mesenteric lymph node complex, liver, spleen and bloodstream [183], Three major mechanisms promote bacterial translocation intestinal bacterial overgrowth, deficiencies in host immune defenses and increased permeability or damage to the intestinal mucosal barrier [184], These mechanisms can act in concert to promote synergistically the systemic spread of indigenous translocating bacteria to cause lethal sepsis. 

Fig. 8. Inhibition of bacterial translocation by rifaximin in the rat. Results of bacteriological culture (for aerobic and anaerobic bacteria) of tissues and biological fluids obtained from rats with taurocholate-induced ANP. Bars represent the percentage of positive biological samples. Horizontal lines are standard errors. Animals of group A received no treatment, while those of group B were given an enema of 30 ml warmed saline containing rifaximin (20 mg/kg) 1 h prior the induction of ANP (from Marotta et al. [196]).

The route of antibiotic administration might be crucial. Animal studies [193, 194] have shown that enteral administration (either by oral or rectal route) of antimicrobials reduces the rate of bacterial translocation and early mortality in rats or mice with experimentally induced pancreatitis. Indeed, in patients with ANP, selective bowel decontamination with oral and rectal antibiotics decreased the infection rate [195]. 

Investigations performed in rats with experimental acute pancreatitis [196] or ulcerative colitis [197] have shown that both rectal and oral administration of rifaximin decreased colonic bacterial translocation towards mesenteric lymph nodes. In the model of ANP [196] not only was the intra-abdominal spread of enteric bacteria (fig. 8) significantly reduced but also the pancreatic damage was lessened by rifaximin treatment. 

Isenmann R, Beger HG Bacterial infection of pancreatic necrosis Role of bacterial translocation, impact of antibiotic treatment. Pan-creatology 2001 1 79-89. 

Dervenis C, Smailis D, Hatzitheoklitos E Bacterial translocation and its prevention in acute pancreatitis. J Hepatobiliary Pancreat Suig 2003 10 415 118. 

Berg RD Bacterial translocation from the gastrointestinal tract. Adv Exp Med Biol 1999 473 11-30. 

Gianotti L, Munda R, Gennari R, Pyles R, Alexander JW Effect of different regimens of gut decontamination on bacterial translocation and mortality in experimental acute pancreatitis. Eur J Surg 1995 161 85-92. 

Marotta F, Geng TC, Wu CC, Barbi G Bacterial translocation in the course of acute pancreatitis Beneficial role of nonabsorbable antibiotics and lactitol enemas. Digestion 1996 57 446-452. 

Fiorucci S, Distrutti E, Mencarelli A, Barban-ti M, Palazzini E, Morelli A Inhibition of intestinal bacterial translocation with rifaximin modulates lamina propria monocytic cells reactivity and protects against inflammation in a rodent model of colitis. Digestion 2002 66 246-256. 

Guarner C, Runyon BA, Young S, Heck M, Sheikh MY Intestinal bacterial overgrowth and bacterial translocation in an experimental model of cirrhosis in rats. J Hepatol 1997 26 1372-1378. 

Cirera I, Bauer TM, Navasa M, Vila J, Grande L, Taura P, Fuster J, Garcia-Valde-casas JC, Lacy A, Suarez MJ, Rimola A, Rodes J Bacterial translocation of enteric organisms in patients with cirrhosis. J Hepatol 2001 34 32-37. 

Guarner C, Runyon BA, Heck M, Young S, Sheikh MY Effect of long-term trimetho-prim/sulfamethoxazole prophylaxis on ascites formation, bacterial translocation, spontaneous bacterial peritonitis and survival in cirrhotic rats. Dig Dis Sci 1999 44 1957— 1962. 

Nieuwenhuijs VB, van Duijvenbode-Beumer H, Verheen A, Visser MR, Vrhoef J, Gooszen HG, Akkermans LMA The effects of ABT-229 and octreotide on interdigestive small bowel motility, bacterial overgrowth and bacterial translocation in rats. Eur J Clin Invest 1999 29 33-40. 

Ui) Bacterial translocation from colon due to hypoxic damage Reperfusion damage to the colonocytes can impair the physical barrier between the contents of the colon and the blood. This leads to translocation of bacteria (some of which are pathogens (e.g. E. coli)), or lipopoly-saccharide (endotoxin) into the peritoneal cavity and evenmaUy into the bloodstream. Activation of the gut-associated immune system results in local inflammation which can also damage the barrier and hence increase bacterial translocation. This sets up a vicious circle, with the development of peritonitis and possible systemic sepsis (Figure 18.6). 

V.V. Nikonov et al, proposed use of massive doses of Enterosgel combined with Eortrans laxative and various eubiotics as the means for prophylaxis of endotox-emia, oxidative stress and bacterial translocation during preparation for surgery associated with the risk of massive blood loss, and in critical state patients with multi-organ insufficiency, severe bums, sepsis, and polytrauma [56]. This scheme may be used for therapy of different pathologies such as chronic hepatitis, allergy and exacerbation of bronchial asthma. 

It is generally accepted that prevention of marrow dysfunction and recovery of hematopoiesis overcome the development of a septic state after bacterial translocation [77,78], The observations of accelerated recovery of stem cell hematopoiesis and protection against peripheral leukopenia suggested that CVS contributed to the prevention of indigenous infection mainly through these effects. 

Yajima, M., Nakayama, M Hatano, S., Yamazaki, K Aoyama, Y Yajima, T et al. (2001). Bacterial translocation in neonatal rats the relation between intestinal flora, translocated bacteria and the influence of milk. J. Ped. Gastroenterol. Nutr. 37,168-177. 

Lemaire, L.C., van Lanschot, J.J., Stoutenbeek, C.P., van Deventer, S.J., Wells, C.L., Gouma, D.J. Bacterial translocation in multiple organ failure cause or epiphenomenon still unproven. Br J... 

Jones IIW., Minei, J., Barber, A., fahey T., Shires III G.T. Splanchnic vasoconstriction and bacterial translocation after thermal injury. Am J Physiol 261 (1991) H1190-H1196. 

Teraguchi, S., Shin, K., Ogata, T., Kingaku, M., Kaino, A., Miyauchi, H., Fukuwatari, Y., and Shimamura, S. 1995a. Orally administered bovine lactoferrin inhibits bacterial translocation in mice fed bovine milk. Appl. Environ. Microb. 61, 4131-4134. 

Pardo A, Bartoli R, Lorenzo-Zuniga V, et al. (2000) Effect of cisapride on intestinal bacterial overgrowth and bacterial translocation in cirrhosis. Hepatology 31 858-863. 

Effects of lactulose on intestinal endotoxin and bacterial translocation in cirrhotic rats. Clin. Med. J. 2003 116 767—771... 

Kasravi, FJ., Adawi, D., Molin, G., Bengmark, S., Jeppsson, B. Effect of oral supplementation of lactobacilh on bacterial translocation in acute hver injury induced by D-galactosamine. J. Hepatol. 1997 26 417-424... 

Vagianos, C., Konreleas, S., Arvanlti, A., Klrkilesis, J., Scopa, CJ)., Dervenis, C., Stavropoulos, M Bacterial translocation and endotoxe-mia in obstructive jaundice the protective effect of lactulose. Dig. Surg. 1995 12 321-326... 

Higashiguchi, T., Ito, A., Kitagawa, M., Taoka, H., Kawarada, Y. Administration of branched-chain amino acids prevents bacterial translocation after liver resection in the cirrhotic rat. Hepat. Bil. Pancr. Surg. 1996 3 291-296... 

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