BACTERIAL TRANSLOCATION AND ENTERAL NUTRITION IN HUMANS - AN OUTSIDERLOOKS IN

Purpose: To assess the literature documenting the existence of bacteri al translocation in humans, the effects of enteral nutrition on bacter ial translocation in humans, and the hypothesis that enteral nutrition prevents bacterial translocation in humans. Data Identification: Sour ces included Medline search, references from review articicles, and re ferences from animal and human studies. Study selection: The goal was to include all animal and human studies directly addressing questions of bacterial translocation and nutritional status or nutritional suppo rt. Data Extraction. An attempt was made to briefly summarize methodol ogy and findings of relevent studies. No general attempt was made to a ssess quality of individual studies. Results of Data Synthesis: Bacter ial translocation is a well documented phenomenon in animal models. St arvation and malnutrition of themselves do not induce bacterial transl ocation, but may facilitate translocation in the presence of other sys temic insults. Parenteral nutrition and many forms of enteral nutritio n may induce and/or facilitate bacterial translocation. Chow and certa in fiber sources seem protective. Moderate direct and several Lines of indirect evidence support the existence of bacterial translocation in humans. There is no direct evidence and questionable indirect evidenc e suggesting that enteral nutrition prevents or modifies bacterial tra nslocation in humans. Conclusions: The hypothesis relating enteral nut rition and bacterial translocation in critically ill patients remains attractive, but unproven.