Skip to main content
PMC home page
Journal of Anatomy logoLink to Journal of Anatomy
. 1996 Dec;189(Pt 3):537–548.

The relationship between gut-derived bacteria and the development of the multiple organ dysfunction syndrome.

G A Nieuwenhuijzen 1, E A Deitch 1, R J Goris 1
PMCID: PMC1167695  PMID: 8982828

Abstract

Abnormal colonisation, infections of gut origin and bacterial translocation are all signs of gut failure that have been hypothesised as being implicated in the pathogenesis of the multiple organ dysfunction syndrome (MODS). We have summarised published experimental and clinical studies that have tried to correlate the occurrence or prevention of these phenomena with the development of MODS. We conclude that in some patients loss of intestinal barrier function or the onset of infection precedes the development of MODS. In other patients, however, this relationship is not so clear and it seems that these are epiphenoma of critical illness and may reflect a failure of the host's immune and mechanical defence systems. The causal relationship between these phenomena and the development of MODS is complex and needs further clarification.

Full text

PDF
539

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aerdts S. J., van Dalen R., Clasener H. A., Festen J., van Lier H. J., Vollaard E. J. Antibiotic prophylaxis of respiratory tract infection in mechanically ventilated patients. A prospective, blinded, randomized trial of the effect of a novel regimen. Chest. 1991 Sep;100(3):783–791. doi: 10.1378/chest.100.3.783. [DOI] [PubMed] [Google Scholar]
  2. Alexander J. W., Boyce S. T., Babcock G. F., Gianotti L., Peck M. D., Dunn D. L., Pyles T., Childress C. P., Ash S. K. The process of microbial translocation. Ann Surg. 1990 Oct;212(4):496–512. doi: 10.1097/00000658-199010000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Alexander J. W., Gianotti L., Pyles T., Carey M. A., Babcock G. F. Distribution and survival of Escherichia coli translocating from the intestine after thermal injury. Ann Surg. 1991 Jun;213(6):558–567. doi: 10.1097/00000658-199106000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Alverdy J. C., Aoys E., Moss G. S. Total parenteral nutrition promotes bacterial translocation from the gut. Surgery. 1988 Aug;104(2):185–190. [PubMed] [Google Scholar]
  5. Ambrose N. S., Johnson M., Burdon D. W., Keighley M. R. Incidence of pathogenic bacteria from mesenteric lymph nodes and ileal serosa during Crohn's disease surgery. Br J Surg. 1984 Aug;71(8):623–625. doi: 10.1002/bjs.1800710821. [DOI] [PubMed] [Google Scholar]
  6. Arden W. A., Yacko M. A., Jay M., Beihn R. M., Derbin M., Gross D. R., Schwartz R. W. Scintigraphic evaluation of bacterial translocation during hemorrhagic shock. J Surg Res. 1993 Feb;54(2):102–106. doi: 10.1006/jsre.1993.1015. [DOI] [PubMed] [Google Scholar]
  7. Atherton S. T., White D. J. Stomach as source of bacteria colonising respiratory tract during artificial ventilation. Lancet. 1978 Nov 4;2(8097):968–969. doi: 10.1016/s0140-6736(78)92530-8. [DOI] [PubMed] [Google Scholar]
  8. Baker J. W., Deitch E. A., Li M., Berg R. D., Specian R. D. Hemorrhagic shock induces bacterial translocation from the gut. J Trauma. 1988 Jul;28(7):896–906. doi: 10.1097/00005373-198807000-00002. [DOI] [PubMed] [Google Scholar]
  9. Bartlett J. G., O'Keefe P., Tally F. P., Louie T. J., Gorbach S. L. Bacteriology of hospital-acquired pneumonia. Arch Intern Med. 1986 May;146(5):868–871. [PubMed] [Google Scholar]
  10. Berg R. D., Garlington A. W. Translocation of certain indigenous bacteria from the gastrointestinal tract to the mesenteric lymph nodes and other organs in a gnotobiotic mouse model. Infect Immun. 1979 Feb;23(2):403–411. doi: 10.1128/iai.23.2.403-411.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Berg R. D. Promotion of the translocation of enteric bacteria from the gastrointestinal tracts of mice by oral treatment with penicillin, clindamycin, or metronidazole. Infect Immun. 1981 Sep;33(3):854–861. doi: 10.1128/iai.33.3.854-861.1981. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Berg R. D., Wommack E., Deitch E. A. Immunosuppression and intestinal bacterial overgrowth synergistically promote bacterial translocation. Arch Surg. 1988 Nov;123(11):1359–1364. doi: 10.1001/archsurg.1988.01400350073011. [DOI] [PubMed] [Google Scholar]
  13. Blair P., Rowlands B. J., Lowry K., Webb H., Armstrong P., Smilie J. Selective decontamination of the digestive tract: a stratified, randomized, prospective study in a mixed intensive care unit. Surgery. 1991 Aug;110(2):303–310. [PubMed] [Google Scholar]
  14. Bonten M. J., Gaillard C. A., van der Geest S. Selective decontamination of the digestive tract. Benefit remains unproved. BMJ. 1993 Dec 11;307(6918):1559–1560. doi: 10.1136/bmj.307.6918.1559-c. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Bonten M. J., van Tiel F. H., van der Geest S., Stobberingh E. E., Gaillard C. A. Enterococcus faecalis pneumonia complicating topical antimicrobial prophylaxis. N Engl J Med. 1993 Jan 21;328(3):209–210. doi: 10.1056/NEJM199301213280311. [DOI] [PubMed] [Google Scholar]
  16. Border J. R., Hassett J., LaDuca J., Seibel R., Steinberg S., Mills B., Losi P., Border D. The gut origin septic states in blunt multiple trauma (ISS = 40) in the ICU. Ann Surg. 1987 Oct;206(4):427–448. doi: 10.1097/00000658-198710000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Brathwaite C. E., Ross S. E., Nagele R., Mure A. J., O'Malley K. F., García-Perez F. A. Bacterial translocation occurs in humans after traumatic injury: evidence using immunofluorescence. J Trauma. 1993 Apr;34(4):586–590. doi: 10.1097/00005373-199304000-00017. [DOI] [PubMed] [Google Scholar]
  18. Brown R. B., Hosmer D., Chen H. C., Teres D., Sands M., Bradley S., Opitz E., Szwedzinski D., Opalenik D. A comparison of infections in different ICUs within the same hospital. Crit Care Med. 1985 Jun;13(6):472–476. doi: 10.1097/00003246-198506000-00006. [DOI] [PubMed] [Google Scholar]
  19. Brun-Buisson C., Legrand P., Rauss A., Richard C., Montravers F., Besbes M., Meakins J. L., Soussy C. J., Lemaire F. Intestinal decontamination for control of nosocomial multiresistant gram-negative bacilli. Study of an outbreak in an intensive care unit. Ann Intern Med. 1989 Jun 1;110(11):873–881. doi: 10.7326/0003-4819-110-11-873. [DOI] [PubMed] [Google Scholar]
  20. Cerra F. B., Maddaus M. A., Dunn D. L., Wells C. L., Konstantinides N. N., Lehmann S. L., Mann H. J. Selective gut decontamination reduces nosocomial infections and length of stay but not mortality or organ failure in surgical intensive care unit patients. Arch Surg. 1992 Feb;127(2):163–169. doi: 10.1001/archsurg.1992.01420020045007. [DOI] [PubMed] [Google Scholar]
  21. Chandrasekar P. H., Kruse J. A., Mathews M. F. Nosocomial infection among patients in different types of intensive care units at a city hospital. Crit Care Med. 1986 May;14(5):508–510. doi: 10.1097/00003246-198605000-00017. [DOI] [PubMed] [Google Scholar]
  22. Chevret S., Hemmer M., Carlet J., Langer M. Incidence and risk factors of pneumonia acquired in intensive care units. Results from a multicenter prospective study on 996 patients. European Cooperative Group on Nosocomial Pneumonia. Intensive Care Med. 1993;19(5):256–264. doi: 10.1007/BF01690545. [DOI] [PubMed] [Google Scholar]
  23. Cockerill F. R., 3rd, Muller S. R., Anhalt J. P., Marsh H. M., Farnell M. B., Mucha P., Gillespie D. J., Ilstrup D. M., Larson-Keller J. J., Thompson R. L. Prevention of infection in critically ill patients by selective decontamination of the digestive tract. Ann Intern Med. 1992 Oct 1;117(7):545–553. doi: 10.7326/0003-4819-117-7-545. [DOI] [PubMed] [Google Scholar]
  24. Craven D. E., Kunches L. M., Kilinsky V., Lichtenberg D. A., Make B. J., McCabe W. R. Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis. 1986 May;133(5):792–796. [PubMed] [Google Scholar]
  25. Craven D. E., Kunches L. M., Lichtenberg D. A., Kollisch N. R., Barry M. A., Heeren T. C., McCabe W. R. Nosocomial infection and fatality in medical and surgical intensive care unit patients. Arch Intern Med. 1988 May;148(5):1161–1168. [PubMed] [Google Scholar]
  26. Danner R. L., Elin R. J., Hosseini J. M., Wesley R. A., Reilly J. M., Parillo J. E. Endotoxemia in human septic shock. Chest. 1991 Jan;99(1):169–175. doi: 10.1378/chest.99.1.169. [DOI] [PubMed] [Google Scholar]
  27. Daschner F. D., Frey P., Wolff G., Baumann P. C., Suter P. Nosocomial infections in intensive care wards: a multicenter prospective study. Intensive Care Med. 1982 Jan;8(1):5–9. doi: 10.1007/BF01686847. [DOI] [PubMed] [Google Scholar]
  28. Daschner F. Nosocomial infections in intensive care units. Intensive Care Med. 1985;11(6):284–287. doi: 10.1007/BF00273537. [DOI] [PubMed] [Google Scholar]
  29. Davis R., Emmonds S. E. Spinal cord stimulation for multiple sclerosis: quantifiable benefits. Stereotact Funct Neurosurg. 1992;58(1-4):52–58. doi: 10.1159/000098972. [DOI] [PubMed] [Google Scholar]
  30. Deitch E. A. Bacterial translocation of the gut flora. J Trauma. 1990 Dec;30(12 Suppl):S184–S189. doi: 10.1097/00005373-199012001-00037. [DOI] [PubMed] [Google Scholar]
  31. Deitch E. A., Berg R., Specian R. Endotoxin promotes the translocation of bacteria from the gut. Arch Surg. 1987 Feb;122(2):185–190. doi: 10.1001/archsurg.1987.01400140067008. [DOI] [PubMed] [Google Scholar]
  32. Deitch E. A., Bridges W. M., Ma J. W., Ma L., Berg R. D., Specian R. D. Obstructed intestine as a reservoir for systemic infection. Am J Surg. 1990 Apr;159(4):394–401. doi: 10.1016/s0002-9610(05)81280-2. [DOI] [PubMed] [Google Scholar]
  33. Deitch E. A., Bridges W., Baker J., Ma J. W., Ma L., Grisham M. B., Granger D. N., Specian R. D., Berg R. Hemorrhagic shock-induced bacterial translocation is reduced by xanthine oxidase inhibition or inactivation. Surgery. 1988 Aug;104(2):191–198. [PubMed] [Google Scholar]
  34. Deitch E. A. Intestinal permeability is increased in burn patients shortly after injury. Surgery. 1990 Apr;107(4):411–416. [PubMed] [Google Scholar]
  35. Deitch E. A., Kemper A. C., Specian R. D., Berg R. D. A study of the relationship among survival, gut-origin sepsis, and bacterial translocation in a model of systemic inflammation. J Trauma. 1992 Feb;32(2):141–147. [PubMed] [Google Scholar]
  36. Deitch E. A., Ma L., Ma W. J., Grisham M. B., Granger D. N., Specian R. D., Berg R. D. Inhibition of endotoxin-induced bacterial translocation in mice. J Clin Invest. 1989 Jul;84(1):36–42. doi: 10.1172/JCI114164. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Deitch E. A., Ma W. J., Ma L., Berg R. D., Specian R. D. Protein malnutrition predisposes to inflammatory-induced gut-origin septic states. Ann Surg. 1990 May;211(5):560–568. doi: 10.1097/00000658-199005000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Deitch E. A., Ma W. J., Ma L., Berg R., Specian R. D. Endotoxin-induced bacterial translocation: a study of mechanisms. Surgery. 1989 Aug;106(2):292–300. [PubMed] [Google Scholar]
  39. Deitch E. A., Maejima K., Berg R. Effect of oral antibiotics and bacterial overgrowth on the translocation of the GI tract microflora in burned rats. J Trauma. 1985 May;25(5):385–392. doi: 10.1097/00005373-198505000-00002. [DOI] [PubMed] [Google Scholar]
  40. Deitch E. A. Multiple organ failure. Pathophysiology and potential future therapy. Ann Surg. 1992 Aug;216(2):117–134. doi: 10.1097/00000658-199208000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Deitch E. A. Simple intestinal obstruction causes bacterial translocation in man. Arch Surg. 1989 Jun;124(6):699–701. doi: 10.1001/archsurg.1989.01410060065013. [DOI] [PubMed] [Google Scholar]
  42. Deitch E. A., Sittig K., Li M., Berg R., Specian R. D. Obstructive jaundice promotes bacterial translocation from the gut. Am J Surg. 1990 Jan;159(1):79–84. doi: 10.1016/s0002-9610(05)80610-5. [DOI] [PubMed] [Google Scholar]
  43. Deitch E. A., Specian R. D., Berg R. D. Endotoxin-induced bacterial translocation and mucosal permeability: role of xanthine oxidase, complement activation, and macrophage products. Crit Care Med. 1991 Jun;19(6):785–791. doi: 10.1097/00003246-199106000-00010. [DOI] [PubMed] [Google Scholar]
  44. Deitch E. A., Specian R. D., Grisham M. B., Berg R. D. Zymosan-induced bacterial translocation: a study of mechanisms. Crit Care Med. 1992 Jun;20(6):782–788. doi: 10.1097/00003246-199206000-00015. [DOI] [PubMed] [Google Scholar]
  45. Deitch E. A., Xu D. Z., Qi L., Berg R. D. Bacterial translocation from the gut impairs systemic immunity. Surgery. 1991 Mar;109(3 Pt 1):269–276. [PubMed] [Google Scholar]
  46. Deitch E. A., Xu D., Franko L., Ayala A., Chaudry I. H. Evidence favoring the role of the gut as a cytokine-generating organ in rats subjected to hemorrhagic shock. Shock. 1994 Feb;1(2):141–145. doi: 10.1097/00024382-199402000-00010. [DOI] [PubMed] [Google Scholar]
  47. Donowitz L. G., Wenzel R. P., Hoyt J. W. High risk of hospital-acquired infection in the ICU patient. Crit Care Med. 1982 Jun;10(6):355–357. doi: 10.1097/00003246-198206000-00001. [DOI] [PubMed] [Google Scholar]
  48. Eickhoff T. C. Nosocomial infections. N Engl J Med. 1982 Jun 24;306(25):1545–1546. doi: 10.1056/NEJM198206243062508. [DOI] [PubMed] [Google Scholar]
  49. Emmerson A. M. The epidemiology of infections in intensive care units. Intensive Care Med. 1990;16 (Suppl 3):S197–S200. doi: 10.1007/BF01709700. [DOI] [PubMed] [Google Scholar]
  50. Fagon J. Y., Chastre J., Domart Y., Trouillet J. L., Pierre J., Darne C., Gibert C. Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis. 1989 Apr;139(4):877–884. doi: 10.1164/ajrccm/139.4.877. [DOI] [PubMed] [Google Scholar]
  51. Ferrer M., Torres A., González J., Puig de la Bellacasa J., el-Ebiary M., Roca M., Gatell J. M., Rodriguez-Roisin R. Utility of selective digestive decontamination in mechanically ventilated patients. Ann Intern Med. 1994 Mar 1;120(5):389–395. doi: 10.7326/0003-4819-120-5-199403010-00006. [DOI] [PubMed] [Google Scholar]
  52. Flaherty J., Nathan C., Kabins S. A., Weinstein R. A. Pilot trial of selective decontamination for prevention of bacterial infection in an intensive care unit. J Infect Dis. 1990 Dec;162(6):1393–1397. doi: 10.1093/infdis/162.6.1393. [DOI] [PubMed] [Google Scholar]
  53. Flanagan J. J., Jr, Rush B. F., Jr, Murphy T. F., Smith S., Machiedo G. W., Hsieh J., Rosa D. M., Heneghan J. B. A "treated" model for severe hemorrhagic shock: a comparison of conventional and germ-free animals. J Med. 1990;21(1-2):104–120. [PubMed] [Google Scholar]
  54. Fox M. A., Peterson S., Fabri B. M., van Saene H. K. Selective decontamination of the digestive tract in cardiac surgical patients. Crit Care Med. 1991 Dec;19(12):1486–1490. doi: 10.1097/00003246-199112000-00008. [DOI] [PubMed] [Google Scholar]
  55. Freeman J., Rosner B. A., McGowan J. E., Jr Adverse effects of nosocomial infection. J Infect Dis. 1979 Nov;140(5):732–740. doi: 10.1093/infdis/140.5.732. [DOI] [PubMed] [Google Scholar]
  56. Fry D. E., Pearlstein L., Fulton R. L., Polk H. C., Jr Multiple system organ failure. The role of uncontrolled infection. Arch Surg. 1980 Feb;115(2):136–140. doi: 10.1001/archsurg.1980.01380020006003. [DOI] [PubMed] [Google Scholar]
  57. Fukushima R., Gianotti L., Alexander J. W., Pyles T. The degree of bacterial translocation is a determinant factor for mortality after burn injury and is improved by prostaglandin analogs. Ann Surg. 1992 Oct;216(4):438–445. doi: 10.1097/00000658-199210000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Garrison R. N., Fry D. E., Berberich S., Polk H. C., Jr Enterococcal bacteremia: clinical implications and determinants of death. Ann Surg. 1982 Jul;196(1):43–47. doi: 10.1097/00000658-198207000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Gastinne H., Wolff M., Delatour F., Faurisson F., Chevret S. A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. The French Study Group on Selective Decontamination of the Digestive Tract. N Engl J Med. 1992 Feb 27;326(9):594–599. doi: 10.1056/NEJM199202273260903. [DOI] [PubMed] [Google Scholar]
  60. Gastinne H., Wolff M., Lachatre G., Boiteau R., Savy F. P. Antibiotic levels in bronchial tree and in serum during selective digestive decontamination. Intensive Care Med. 1991;17(4):215–218. doi: 10.1007/BF01709880. [DOI] [PubMed] [Google Scholar]
  61. Gerkin T. M., Oldham K. T., Guice K. S., Hinshaw D. B., Ryan U. S. Intestinal ischemia-reperfusion injury causes pulmonary endothelial cell ATP depletion. Ann Surg. 1993 Jan;217(1):48–56. doi: 10.1097/00000658-199301000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Godard J., Guillaume C., Reverdy M. E., Bachmann P., Bui-Xuan B., Nageotte A., Motin J. Intestinal decontamination in a polyvalent ICU. A double-blind study. Intensive Care Med. 1990;16(5):307–311. doi: 10.1007/BF01706355. [DOI] [PubMed] [Google Scholar]
  63. Goris R. J., Boekholtz W. K., van Bebber I. P., Nuytinck J. K., Schillings P. H. Multiple-organ failure and sepsis without bacteria. An experimental model. Arch Surg. 1986 Aug;121(8):897–901. doi: 10.1001/archsurg.1986.01400080039006. [DOI] [PubMed] [Google Scholar]
  64. Goris R. J., te Boekhorst T. P., Nuytinck J. K., Gimbrère J. S. Multiple-organ failure. Generalized autodestructive inflammation? Arch Surg. 1985 Oct;120(10):1109–1115. doi: 10.1001/archsurg.1985.01390340007001. [DOI] [PubMed] [Google Scholar]
  65. Goris R. J., van Bebber I. P., Mollen R. M., Koopman J. P. Does selective decontamination of the gastrointestinal tract prevent multiple organ failure? An experimental study. Arch Surg. 1991 May;126(5):561–565. doi: 10.1001/archsurg.1991.01410290033006. [DOI] [PubMed] [Google Scholar]
  66. Gross P. A., Neu H. C., Aswapokee P., Van Antwerpen C., Aswapokee N. Deaths from nosocomial infections: experience in a university hospital and a community hospital. Am J Med. 1980 Feb;68(2):219–223. doi: 10.1016/0002-9343(80)90357-5. [DOI] [PubMed] [Google Scholar]
  67. Gross P. A., Van Antwerpen C. Nosocomial infections and hospital deaths. A case-control study. Am J Med. 1983 Oct;75(4):658–662. doi: 10.1016/0002-9343(83)90453-9. [DOI] [PubMed] [Google Scholar]
  68. Guzman-Stein G., Bonsack M., Liberty J., Delaney J. P. Abdominal radiation causes bacterial translocation. J Surg Res. 1989 Feb;46(2):104–107. doi: 10.1016/0022-4804(89)90211-4. [DOI] [PubMed] [Google Scholar]
  69. Hammond J. M., Potgieter P. D. Neurologic disease requiring long-term ventilation. The role of selective decontamination of the digestive tract in preventing nosocomial infection. Chest. 1993 Aug;104(2):547–551. doi: 10.1378/chest.104.2.547. [DOI] [PubMed] [Google Scholar]
  70. Hammond J. M., Potgieter P. D., Saunders G. L., Forder A. A. Double-blind study of selective decontamination of the digestive tract in intensive care. Lancet. 1992 Jul 4;340(8810):5–9. doi: 10.1016/0140-6736(92)92422-c. [DOI] [PubMed] [Google Scholar]
  71. Hammond J. M., Potgieter P. D., Saunders G. L. Selective decontamination of the digestive tract in multiple trauma patients--is there a role? Results of a prospective, double-blind, randomized trial. Crit Care Med. 1994 Jan;22(1):33–39. doi: 10.1097/00003246-199401000-00010. [DOI] [PubMed] [Google Scholar]
  72. Hartenauer U., Thülig B., Diemer W., Lawin P., Fegeler W., Kehrel R., Ritzerfeld W. Effect of selective flora suppression on colonization, infection, and mortality in critically ill patients: a one-year, prospective consecutive study. Crit Care Med. 1991 Apr;19(4):463–473. doi: 10.1097/00003246-199104000-00003. [DOI] [PubMed] [Google Scholar]
  73. Herndon D. N., Zeigler S. T. Bacterial translocation after thermal injury. Crit Care Med. 1993 Feb;21(2 Suppl):S50–S54. doi: 10.1097/00003246-199302001-00010. [DOI] [PubMed] [Google Scholar]
  74. Heyland D. K., Cook D. J., Jaeschke R., Griffith L., Lee H. N., Guyatt G. H. Selective decontamination of the digestive tract. An overview. Chest. 1994 Apr;105(4):1221–1229. doi: 10.1378/chest.105.4.1221. [DOI] [PubMed] [Google Scholar]
  75. Hünefeld G. Klinische Studie zur selektiven Darmdekolonisation bei 204 langzeitbeatmeten abdominal- und unfallchirurgischen Intensivpatienten. Anaesthesiol Reanim. 1989;14(3):131–153. [PubMed] [Google Scholar]
  76. Jarrett F., Balish E., Moylan J. A., Ellerbe S. Clinical experience with prophylactic antibiotic bowel suppression in burn patients. Surgery. 1978 May;83(5):523–527. [PubMed] [Google Scholar]
  77. Johanson W. G., Jr, Pierce A. K., Sanford J. P., Thomas G. D. Nosocomial respiratory infections with gram-negative bacilli. The significance of colonization of the respiratory tract. Ann Intern Med. 1972 Nov;77(5):701–706. doi: 10.7326/0003-4819-77-5-701. [DOI] [PubMed] [Google Scholar]
  78. Jones W. G., 2nd, Minei J. P., Barber A. E., Rayburn J. L., Fahey T. J., 3rd, Shires G. T., 3rd, Shires G. T. Bacterial translocation and intestinal atrophy after thermal injury and burn wound sepsis. Ann Surg. 1990 Apr;211(4):399–405. doi: 10.1097/00000658-199004000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  79. Kerver A. J., Rommes J. H., Mevissen-Verhage E. A., Hulstaert P. F., Vos A., Verhoef J., Wittebol P. Colonization and infection in surgical intensive care patients--a prospective study. Intensive Care Med. 1987;13(5):347–351. doi: 10.1007/BF00255792. [DOI] [PubMed] [Google Scholar]
  80. Kerver A. J., Rommes J. H., Mevissen-Verhage E. A., Hulstaert P. F., Vos A., Verhoef J., Wittebol P. Prevention of colonization and infection in critically ill patients: a prospective randomized study. Crit Care Med. 1988 Nov;16(11):1087–1093. doi: 10.1097/00003246-198811000-00001. [DOI] [PubMed] [Google Scholar]
  81. Knaus W. A., Wagner D. P. Multiple systems organ failure: epidemiology and prognosis. Crit Care Clin. 1989 Apr;5(2):221–232. [PubMed] [Google Scholar]
  82. Kollef M. H. The role of selective digestive tract decontamination on mortality and respiratory tract infections. A meta-analysis. Chest. 1994 Apr;105(4):1101–1108. doi: 10.1378/chest.105.4.1101. [DOI] [PubMed] [Google Scholar]
  83. Konrad F., Schwalbe B., Heeg K., Wagner H., Wiedeck H., Kilian J., Ahnefeld F. W. Kolonisations-, Pneumoniefrequenz und Resistenzentwicklung bei langzeitbeatmeten Intensivpatienten unter selektiver Dekontamination des Verdauungstraktes. Anaesthesist. 1989 Mar;38(3):99–109. [PubMed] [Google Scholar]
  84. Korinek A. M., Laisne M. J., Nicolas M. H., Raskine L., Deroin V., Sanson-Lepors M. J. Selective decontamination of the digestive tract in neurosurgical intensive care unit patients: a double-blind, randomized, placebo-controlled study. Crit Care Med. 1993 Oct;21(10):1466–1473. doi: 10.1097/00003246-199310000-00013. [DOI] [PubMed] [Google Scholar]
  85. Koziol J. M., Rush B. F., Jr, Smith S. M., Machiedo G. W. Occurrence of bacteremia during and after hemorrhagic shock. J Trauma. 1988 Jan;28(1):10–16. [PubMed] [Google Scholar]
  86. Langer M., Cigada M., Mandelli M., Mosconi P., Tognoni G. Early onset pneumonia: a multicenter study in intensive care units. Intensive Care Med. 1987;13(5):342–346. doi: 10.1007/BF00255791. [DOI] [PubMed] [Google Scholar]
  87. LeVoyer T., Cioffi W. G., Jr, Pratt L., Shippee R., McManus W. F., Mason A. D., Jr, Pruitt B. A., Jr Alterations in intestinal permeability after thermal injury. Arch Surg. 1992 Jan;127(1):26–30. doi: 10.1001/archsurg.1992.01420010032005. [DOI] [PubMed] [Google Scholar]
  88. Ledingham I. M., Alcock S. R., Eastaway A. T., McDonald J. C., McKay I. C., Ramsay G. Triple regimen of selective decontamination of the digestive tract, systemic cefotaxime, and microbiological surveillance for prevention of acquired infection in intensive care. Lancet. 1988 Apr 9;1(8589):785–790. doi: 10.1016/s0140-6736(88)91656-x. [DOI] [PubMed] [Google Scholar]
  89. Leu H. S., Kaiser D. L., Mori M., Woolson R. F., Wenzel R. P. Hospital-acquired pneumonia. Attributable mortality and morbidity. Am J Epidemiol. 1989 Jun;129(6):1258–1267. doi: 10.1093/oxfordjournals.aje.a115245. [DOI] [PubMed] [Google Scholar]
  90. Li M., Specian R. D., Berg R. D., Deitch E. A. Effects of protein malnutrition and endotoxin on the intestinal mucosal barrier to the translocation of indigenous flora in mice. JPEN J Parenter Enteral Nutr. 1989 Nov-Dec;13(6):572–578. doi: 10.1177/0148607189013006572. [DOI] [PubMed] [Google Scholar]
  91. Ma L., Ma J. W., Deitch E. A., Specian R. D., Berg R. D. Genetic susceptibility to mucosal damage leads to bacterial translocation in a murine burn model. J Trauma. 1989 Sep;29(9):1245–1251. doi: 10.1097/00005373-198909000-00010. [DOI] [PubMed] [Google Scholar]
  92. Mackie D. P., van Hertum W. A., Schumburg T., Kuijper E. C., Knape P. Prevention of infection in burns: preliminary experience with selective decontamination of the digestive tract in patients with extensive injuries. J Trauma. 1992 May;32(5):570–575. [PubMed] [Google Scholar]
  93. Maejima K., Deitch E. A., Berg R. D. Bacterial translocation from the gastrointestinal tracts of rats receiving thermal injury. Infect Immun. 1984 Jan;43(1):6–10. doi: 10.1128/iai.43.1.6-10.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  94. Maejima K., Deitch E., Berg R. Promotion by burn stress of the translocation of bacteria from the gastrointestinal tracts of mice. Arch Surg. 1984 Feb;119(2):166–172. doi: 10.1001/archsurg.1984.01390140032006. [DOI] [PubMed] [Google Scholar]
  95. Mainous M. R., Tso P., Berg R. D., Deitch E. A. Studies of the route, magnitude, and time course of bacterial translocation in a model of systemic inflammation. Arch Surg. 1991 Jan;126(1):33–37. doi: 10.1001/archsurg.1991.01410250037005. [DOI] [PubMed] [Google Scholar]
  96. Mainous M. R., Xu D., Deitch E. A. Role of xanthine oxidase and prostaglandins in inflammatory-induced bacterial translocation. Circ Shock. 1993 Jun;40(2):99–104. [PubMed] [Google Scholar]
  97. Mainous M., Xu D. Z., Lu Q., Berg R. D., Deitch E. A. Oral-TPN-induced bacterial translocation and impaired immune defenses are reversed by refeeding. Surgery. 1991 Aug;110(2):277–284. [PubMed] [Google Scholar]
  98. Marshall J. C., Christou N. V., Horn R., Meakins J. L. The microbiology of multiple organ failure. The proximal gastrointestinal tract as an occult reservoir of pathogens. Arch Surg. 1988 Mar;123(3):309–315. doi: 10.1001/archsurg.1988.01400270043006. [DOI] [PubMed] [Google Scholar]
  99. Marshall J. C., Christou N. V., Meakins J. L. Immunomodulation by altered gastrointestinal tract flora. The effects of orally administered, killed Staphylococcus epidermidis, Candida, and Pseudomonas on systemic immune responses. Arch Surg. 1988 Dec;123(12):1465–1469. doi: 10.1001/archsurg.1988.01400360035004. [DOI] [PubMed] [Google Scholar]
  100. Marshall J. C., Christou N. V., Meakins J. L. The gastrointestinal tract. The "undrained abscess" of multiple organ failure. Ann Surg. 1993 Aug;218(2):111–119. doi: 10.1097/00000658-199308000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  101. Marshall J., Sweeney D. Microbial infection and the septic response in critical surgical illness. Sepsis, not infection, determines outcome. Arch Surg. 1990 Jan;125(1):17–23. doi: 10.1001/archsurg.1990.01410130019002. [DOI] [PubMed] [Google Scholar]
  102. Martinez-Pellús A. E., Merino P., Bru M., Conejero R., Seller G., Muñoz C., Fuentes T., Gonzalez G., Alvarez B. Can selective digestive decontamination avoid the endotoxemia and cytokine activation promoted by cardiopulmonary bypass? Crit Care Med. 1993 Nov;21(11):1684–1691. doi: 10.1097/00003246-199311000-00017. [DOI] [PubMed] [Google Scholar]
  103. McClelland P., Coakley J., Williams P. S., Bone J. M., Mostafa S. M., Williams P. G. Staphylococcal peritonitis following selective decontamination of digestive tract. Lancet. 1988 Oct 1;2(8614):800–800. doi: 10.1016/s0140-6736(88)92455-5. [DOI] [PubMed] [Google Scholar]
  104. McClelland P., Murray A. E., Williams P. S., van Saene H. K., Gilbertson A. A., Mostafa S. M., Bone J. M. Reducing sepsis in severe combined acute renal and respiratory failure by selective decontamination of the digestive tract. Crit Care Med. 1990 Sep;18(9):935–939. doi: 10.1097/00003246-199009000-00006. [DOI] [PubMed] [Google Scholar]
  105. Meta-analysis of randomised controlled trials of selective decontamination of the digestive tract. Selective Decontamination of the Digestive Tract Trialists' Collaborative Group. BMJ. 1993 Aug 28;307(6903):525–532. doi: 10.1136/bmj.307.6903.525. [DOI] [PMC free article] [PubMed] [Google Scholar]
  106. Miranda D. R., Van Saene H. K., Stoutenbeek C. P., Zandstra D. F. Environment and costs in surgical intensive care unit. The implication of selective decontamination of the digestive tract (SDD). Acta Anaesthesiol Belg. 1983 Sep;34(3):223–232. [PubMed] [Google Scholar]
  107. Moore F. A., Moore E. E., Poggetti R., McAnena O. J., Peterson V. M., Abernathy C. M., Parsons P. E. Gut bacterial translocation via the portal vein: a clinical perspective with major torso trauma. J Trauma. 1991 May;31(5):629–638. doi: 10.1097/00005373-199105000-00006. [DOI] [PubMed] [Google Scholar]
  108. Munster A. M., Smith-Meek M., Dickerson C., Winchurch R. A. Translocation. Incidental phenomenon or true pathology? Ann Surg. 1993 Sep;218(3):321–327. doi: 10.1097/00000658-199309000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  109. Nardi G., Valentinis U., Proietti A., De Monte A., Di Silvestre A., Muzzi R., Peressutti R., Troncon M. G., Giordano F. Epidemiological impact of prolonged systematic use of topical SDD on bacterial colonization of the tracheobronchial tree and antibiotic resistance. A three year study. Intensive Care Med. 1993;19(5):273–278. doi: 10.1007/BF01690547. [DOI] [PubMed] [Google Scholar]
  110. Nathens A. B., Chu P. T., Marshall J. C. Nosocomial infection in the surgical intensive care unit. Infect Dis Clin North Am. 1992 Sep;6(3):657–675. [PubMed] [Google Scholar]
  111. Nieuwenhuijzen G. A., Haskel Y., Lu Q., Berg R. D., van Rooijen N., Goris R. J., Deitch E. A. Macrophage elimination increases bacterial translocation and gut-origin septicemia but attenuates symptoms and mortality rate in a model of systemic inflammation. Ann Surg. 1993 Dec;218(6):791–799. doi: 10.1097/00000658-199312000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  112. Northey D., Adess M. L., Hartsuck J. M., Rhoades E. R. Microbial surveillance in a surgical intensive care unit. Surg Gynecol Obstet. 1974 Sep;139(3):321–325. [PubMed] [Google Scholar]
  113. Norton L. W. Does drainage of intraabdominal pus reverse multiple organ failure? Am J Surg. 1985 Mar;149(3):347–350. doi: 10.1016/s0002-9610(85)80105-7. [DOI] [PubMed] [Google Scholar]
  114. Owens W. E., Berg R. D. Bacterial translocation from the gastrointestinal tract of athymic (nu/nu) mice. Infect Immun. 1980 Feb;27(2):461–467. doi: 10.1128/iai.27.2.461-467.1980. [DOI] [PMC free article] [PubMed] [Google Scholar]
  115. Peitzman A. B., Udekwu A. O., Ochoa J., Smith S. Bacterial translocation in trauma patients. J Trauma. 1991 Aug;31(8):1083–1087. [PubMed] [Google Scholar]
  116. Poggetti R. S., Moore F. A., Moore E. E., Koeike K., Banerjee A. Simultaneous liver and lung injury following gut ischemia is mediated by xanthine oxidase. J Trauma. 1992 Jun;32(6):723–728. doi: 10.1097/00005373-199206000-00008. [DOI] [PubMed] [Google Scholar]
  117. Polk H. C., Jr, Shields C. L. Remote organ failure: a valid sign of occult intra-abdominal infection. Surgery. 1977 Mar;81(3):310–313. [PubMed] [Google Scholar]
  118. Pugin J., Auckenthaler R., Lew D. P., Suter P. M. Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia. A randomized, placebo-controlled, double-blind clinical trial. JAMA. 1991 May 22;265(20):2704–2710. [PubMed] [Google Scholar]
  119. Reed L. L., Martin M., Manglano R., Newson B., Kocka F., Barrett J. Bacterial translocation following abdominal trauma in humans. Circ Shock. 1994 Jan;42(1):1–6. [PubMed] [Google Scholar]
  120. Rocha L. A., Martín M. J., Pita S., Paz J., Seco C., Margusino L., Villanueva R., Durán M. T. Prevention of nosocomial infection in critically ill patients by selective decontamination of the digestive tract. A randomized, double blind, placebo-controlled study. Intensive Care Med. 1992;18(7):398–404. doi: 10.1007/BF01694341. [DOI] [PubMed] [Google Scholar]
  121. Rodríguez-Roldán J. M., Altuna-Cuesta A., López A., Carrillo A., Garcia J., León J., Martínez-Pellús A. J. Prevention of nosocomial lung infection in ventilated patients: use of an antimicrobial pharyngeal nonabsorbable paste. Crit Care Med. 1990 Nov;18(11):1239–1242. doi: 10.1097/00003246-199011000-00011. [DOI] [PubMed] [Google Scholar]
  122. Rolando N., Gimson A., Wade J., Philpott-Howard J., Casewell M., Williams R. Prospective controlled trial of selective parenteral and enteral antimicrobial regimen in fulminant liver failure. Hepatology. 1993 Feb;17(2):196–201. [PubMed] [Google Scholar]
  123. Rosman C., Wübbels G. H., Manson W. L., Bleichrodt R. P. Selective decontamination of the digestive tract prevents secondary infection of the abdominal cavity, and endotoxemia and mortality in sterile peritonitis in laboratory rats. Crit Care Med. 1992 Dec;20(12):1699–1704. doi: 10.1097/00003246-199212000-00017. [DOI] [PubMed] [Google Scholar]
  124. Roumen R. M., Hendriks T., Wevers R. A., Goris J. A. Intestinal permeability after severe trauma and hemorrhagic shock is increased without relation to septic complications. Arch Surg. 1993 Apr;128(4):453–457. doi: 10.1001/archsurg.1993.01420160095016. [DOI] [PubMed] [Google Scholar]
  125. Salman F. T., Buyruk M. N., Gürler N., Celik A. The effect of surgical trauma on the bacterial translocation from the gut. J Pediatr Surg. 1992 Jul;27(7):802–804. doi: 10.1016/0022-3468(92)90368-h. [DOI] [PubMed] [Google Scholar]
  126. Schmeling D. J., Caty M. G., Oldham K. T., Guice K. S., Hinshaw D. B. Evidence for neutrophil-related acute lung injury after intestinal ischemia-reperfusion. Surgery. 1989 Aug;106(2):195–202. [PubMed] [Google Scholar]
  127. Slocum M. M., Sittig K. M., Specian R. D., Deitch E. A. Absence of intestinal bile promotes bacterial translocation. Am Surg. 1992 May;58(5):305–310. [PubMed] [Google Scholar]
  128. Sori A. J., Rush B. F., Jr, Lysz T. W., Smith S., Machiedo G. W. The gut as source of sepsis after hemorrhagic shock. Am J Surg. 1988 Feb;155(2):187–192. doi: 10.1016/s0002-9610(88)80691-3. [DOI] [PubMed] [Google Scholar]
  129. Spaeth G., Specian R. D., Berg R. D., Deitch E. A. Bulk prevents bacterial translocation induced by the oral administration of total parenteral nutrition solution. JPEN J Parenter Enteral Nutr. 1990 Sep-Oct;14(5):442–447. doi: 10.1177/0148607190014005442. [DOI] [PubMed] [Google Scholar]
  130. Stevens R. M., Teres D., Skillman J. J., Feingold D. S. Pneumonia in an intensive care unit. A 30-month experience. Arch Intern Med. 1974 Jul;134(1):106–111. [PubMed] [Google Scholar]
  131. Stoutenbeek C. P., van Saene H. K., Miranda D. R., Zandstra D. F., Langrehr D. The effect of oropharyngeal decontamination using topical nonabsorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients. J Trauma. 1987 Apr;27(4):357–364. doi: 10.1097/00005373-198704000-00003. [DOI] [PubMed] [Google Scholar]
  132. Stoutenbeek C. P., van Saene H. K., Miranda D. R., Zandstra D. F. The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients. Intensive Care Med. 1984;10(4):185–192. doi: 10.1007/BF00259435. [DOI] [PubMed] [Google Scholar]
  133. Sullivan B. J., Swallow C. J., Girotti M. J., Rotstein O. D. Bacterial translocation induces procoagulant activity in tissue macrophages. A potential mechanism for end-organ dysfunction. Arch Surg. 1991 May;126(5):586–590. doi: 10.1001/archsurg.1991.01410290062013. [DOI] [PubMed] [Google Scholar]
  134. Sydow M., Burchardi H., Crozier T. A., Rüchel R., Busse C., Seyde W. C. Einfluss der selektiven Dekontamination auf nosokomiale Infektionen, Erregerspektrum und Antibiotikaresistenz bei langzeitbeatmeten Intensivpatienten. Anasth Intensivther Notfallmed. 1990 Dec;25(6):416–423. [PubMed] [Google Scholar]
  135. Tetteroo G. W., Wagenvoort J. H., Castelein A., Tilanus H. W., Ince C., Bruining H. A. Selective decontamination to reduce gram-negative colonisation and infections after oesophageal resection. Lancet. 1990 Mar 24;335(8691):704–707. doi: 10.1016/0140-6736(90)90813-k. [DOI] [PubMed] [Google Scholar]
  136. Tetteroo G. W., Wagenvoort J. H., Mulder P. G., Ince C., Bruining H. A. Decreased mortality rate and length of hospital stay in surgical intensive care unit patients with successful selective decontamination of the gut. Crit Care Med. 1993 Nov;21(11):1692–1698. doi: 10.1097/00003246-199311000-00018. [DOI] [PubMed] [Google Scholar]
  137. Thülig B., Hartenauer U., Diemer W., Lawin P., Fegeler W., Kehrel R., Ritzerfeld W. Selektive Florasuppression zur Infektionskontrolle in der operativen Intensivmedizin. Anasth Intensivther Notfallmed. 1989 Dec;24(6):345–354. [PubMed] [Google Scholar]
  138. Ulrich C., Harinck-de Weerd J. E., Bakker N. C., Jacz K., Doornbos L., de Ridder V. A. Selective decontamination of the digestive tract with norfloxacin in the prevention of ICU-acquired infections: a prospective randomized study. Intensive Care Med. 1989;15(7):424–431. doi: 10.1007/BF00255597. [DOI] [PubMed] [Google Scholar]
  139. Unertl K., Ruckdeschel G., Selbmann H. K., Jensen U., Forst H., Lenhart F. P., Peter K. Prevention of colonization and respiratory infections in long-term ventilated patients by local antimicrobial prophylaxis. Intensive Care Med. 1987;13(2):106–113. doi: 10.1007/BF00254795. [DOI] [PubMed] [Google Scholar]
  140. Vandenbroucke-Grauls C. M., Vandenbroucke J. P. Effect of selective decontamination of the digestive tract on respiratory tract infections and mortality in the intensive care unit. Lancet. 1991 Oct 5;338(8771):859–862. doi: 10.1016/0140-6736(91)91510-2. [DOI] [PubMed] [Google Scholar]
  141. Waydhas C., Nast-Kolb D., Jochum M., Trupka A., Lenk S., Fritz H., Duswald K. H., Schweiberer L. Inflammatory mediators, infection, sepsis, and multiple organ failure after severe trauma. Arch Surg. 1992 Apr;127(4):460–467. doi: 10.1001/archsurg.1992.01420040106019. [DOI] [PubMed] [Google Scholar]
  142. Wells C. L., Balish E. Immune response modulation by colonization of germfree rats with Propionibacterium acnes. Infect Immun. 1979 Nov;26(2):473–478. doi: 10.1128/iai.26.2.473-478.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
  143. Wells C. L., Jechorek R. P., Erlandsen S. L. Evidence for the translocation of Enterococcus faecalis across the mouse intestinal tract. J Infect Dis. 1990 Jul;162(1):82–90. doi: 10.1093/infdis/162.1.82. [DOI] [PubMed] [Google Scholar]
  144. Wells C. L., Jechorek R. P., Gillingham K. J. Relative contributions of host and microbial factors in bacterial translocation. Arch Surg. 1991 Feb;126(2):247–252. doi: 10.1001/archsurg.1991.01410260137020. [DOI] [PubMed] [Google Scholar]
  145. Wells C. L., Maddaus M. A., Erlandsen S. L., Simmons R. L. Evidence for the phagocytic transport of intestinal particles in dogs and rats. Infect Immun. 1988 Jan;56(1):278–282. doi: 10.1128/iai.56.1.278-282.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  146. Wells C. L., Maddaus M. A., Reynolds C. M., Jechorek R. P., Simmons R. L. Role of anaerobic flora in the translocation of aerobic and facultatively anaerobic intestinal bacteria. Infect Immun. 1987 Nov;55(11):2689–2694. doi: 10.1128/iai.55.11.2689-2694.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  147. Wells C. L., Maddaus M. A., Simmons R. L. Role of the macrophage in the translocation of intestinal bacteria. Arch Surg. 1987 Jan;122(1):48–53. doi: 10.1001/archsurg.1987.01400130054008. [DOI] [PubMed] [Google Scholar]
  148. Winchurch R. A., Thupari J. N., Munster A. M. Endotoxemia in burn patients: levels of circulating endotoxins are related to burn size. Surgery. 1987 Nov;102(5):808–812. [PubMed] [Google Scholar]
  149. Winter R., Humphreys H., Pick A., MacGowan A. P., Willatts S. M., Speller D. C. A controlled trial of selective decontamination of the digestive tract in intensive care and its effect on nosocomial infection. J Antimicrob Chemother. 1992 Jul;30(1):73–87. doi: 10.1093/jac/30.1.73. [DOI] [PubMed] [Google Scholar]
  150. Wolochow H., Hildebrand G. J., Lamanna C. Translocation of microorganisms across the intestinal wall of the rat: effect of microbial size and concentration. J Infect Dis. 1966 Oct;116(4):523–528. doi: 10.1093/infdis/116.4.523. [DOI] [PubMed] [Google Scholar]
  151. Ziegler E. J., Fisher C. J., Jr, Sprung C. L., Straube R. C., Sadoff J. C., Foulke G. E., Wortel C. H., Fink M. P., Dellinger R. P., Teng N. N. Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin. A randomized, double-blind, placebo-controlled trial. The HA-1A Sepsis Study Group. N Engl J Med. 1991 Feb 14;324(7):429–436. doi: 10.1056/NEJM199102143240701. [DOI] [PubMed] [Google Scholar]
  152. Ziegler T. R., Smith R. J., O'Dwyer S. T., Demling R. H., Wilmore D. W. Increased intestinal permeability associated with infection in burn patients. Arch Surg. 1988 Nov;123(11):1313–1319. doi: 10.1001/archsurg.1988.01400350027003. [DOI] [PubMed] [Google Scholar]
  153. van Deventer S. J., Buller H. R., ten Cate J. W., Sturk A., Pauw W. Endotoxaemia: an early predictor of septicaemia in febrile patients. Lancet. 1988 Mar 19;1(8586):605–609. doi: 10.1016/s0140-6736(88)91412-2. [DOI] [PubMed] [Google Scholar]
  154. van Goor H., Rosman C., Grond J., Kooi K., Wübbels G. H., Bleichrodt R. P. Translocation of bacteria and endotoxin in organ donors. Arch Surg. 1994 Oct;129(10):1063–1066. doi: 10.1001/archsurg.1994.01420340077014. [DOI] [PubMed] [Google Scholar]
  155. van der Waaij D., Berghuis-de Vries J. M., Lekkerkerk Lekkerkerk-v Colonization resistance of the digestive tract in conventional and antibiotic-treated mice. J Hyg (Lond) 1971 Sep;69(3):405–411. doi: 10.1017/s0022172400021653. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Anatomy are provided here courtesy of Anatomical Society of Great Britain and Ireland

RESOURCES