BACTERIAL TRANSLOCATION OCCURS IN HUMANS AFTER TRAUMATIC INJURY - EVIDENCE USING IMMUNOFLUORESCENCE

We evaluated the occurrence of bacterial translocation (BT) in humans after traumatic injury. Twenty trauma patients (18 with blunt trauma) requiring celiotomy and without hollow viscus injury were studied. Aft er surgical hemostasis and repair, portal venous blood (PVB) was sampl ed for culture. Additionally, a mesenteric lymph node (MLN) was harves ted for culture and indirect immunofluorescence analysis using, first, mouse monoclonal antibody to E. coli beta-galactosidase, then goat an ti-mouse immunoglobulin G (IgG). Injury Severity Score (ISS), Trauma S core (TS), and period of hemorrhagic shock (HS; systolic BP < 90 mm Hg with blood loss > 500 mL) were recorded before specimens were obtaine d. Results: Fifteen patients initially had HS (mean period of 60 minut es). Mean TS and ISS were 10 and 29, respectively. Seven patients did not have HS (mean TS and ISS, 10 and 13). Three patients received anti biotics preoperatively. Portal venous blood culture produced positive results in only three patients (two with HS) and culture of the MLN sp ecimen was positive in one. However E. coli beta-galactosidase was det ected within the cytoplasm of macrophages in all MLNs. One patient dev eloped multiple organ failure. Conclusion: Bacterial translocation occ urs in humans following traumatic injury and may be independent of HS. Culture techniques may not detect BT since organisms may have been ph agocytized by macrophages. The clinical significance of BT in trauma p atients remains unclear.