Bacterial translocation in patients undergoing major gastrointestinal surgery and its role in postoperative sepsis

Abstract

Bacteria of the human intestinal microflora have a dual role. They promote digestion and are part of a defense mechanism against pathogens. These bacteria could become potential pathogens under certain circumstances. The term “bacterial translocation” describes the passage of bacteria of the gastrointestinal tract through the intestinal mucosa barrier to mesenteric lymph nodes and other organs. In some cases, the passage of bacteria and endotoxins could result in blood stream infections and in multiple organ failure. Open elective abdominal surgery more frequently results in malfunction of the intestinal barrier and subsequent bacterial translocation and blood stream infections than laparoscopic surgery. Postoperative sepsis is a common finding in patients who have undergone non-elective abdominal surgeries, including trauma patients treated with laparotomy. Postoperative sepsis is an emerging issue, as it changes the treatment plan in surgical patients and prolongs hospital stay. The association between bacterial translocation and postoperative sepsis could provide novel treatment options.

Keywords: Bacterial translocation; Major gastrointestinal surgery; Postoperative sepsis; Intestinal permeability; Microbiota

Core Tip: Increased intestinal permeability can potentially induce intestinal flora dysbiosis. Bacterial translocation, attributed to intestinal barrier impairment, may lead to systematic infection in the postoperative period. The definitive correlation between translocation and postoperative sepsis is yet to be proven, but the latter is an emerging issue for patients undergoing major gastrointestinal surgeries.