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. 1993 Mar;217(3):286–292. doi: 10.1097/00000658-199303000-00011

Effect of total parenteral nutrition plus morphine on bacterial translocation in rats.

P M Kueppers 1, T A Miller 1, C Y Chen 1, G S Smith 1, L F Rodriguez 1, F G Moody 1
PMCID: PMC1242782  PMID: 8452407

Abstract

OBJECTIVE: This study tested the hypothesis that gut stasis induced by parenteral morphine sulfate (MS) leads to enhanced bacterial translocation in rats on total parenteral nutrition (TPN). SUMMARY BACKGROUND DATA: TPN and MS are common adjuncts in the care of critically ill patients. TPN is known to provoke a variable degree of translocation. MS induces gut stasis with an accompanying bacterial overgrowth. The effect of these two treatments in combination on translocation is not known. METHODS: Rats were provided with central and subcutaneous lines for the continuous infusion of nutrients and drugs, respectively. Intestinal transit was assessed by the caudal movement of a fluorescent marker intubated into the proximal duodenum. Quantitative bacteriology was carried out from various segments of the gut and from ileocecal mesenteric lymph nodes (MLN), spleen, liver, and systemic blood obtained by cardia puncture on sacrifice at 96 hours. RESULTS: Transit was unchanged by TPN alone but prolonged when given in combination with MS. Bacterial overgrowth was also enhanced by MS and increased the bacterial translocation to MLN from 50% of animals with TPN, to 100% in those receiving both TPN and MS; the colony-forming units per MLN increased from 33 +/- 14 with TPN alone to 2079 +/- 811 (STD) with TPN plus MS. Furthermore, no bacteria were found at systemic sites with TPN alone, but in 93.3% of animals receiving TPN and MS. In a subgroup of rates provided with glutamine in TPN, the TPN plus MS effects on translocation were not reversed. CONCLUSIONS: These observations demonstrate the important role that morphine plays in promoting translocation, presumably by disrupting fasting motility and enhancing bacterial overgrowth.

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Selected References

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  1. 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]
  2. Alverdy J., Chi H. S., Sheldon G. F. The effect of parenteral nutrition on gastrointestinal immunity. The importance of enteral stimulation. Ann Surg. 1985 Dec;202(6):681–684. doi: 10.1097/00000658-198512000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Barber A. E., Jones W. G., 2nd, Minei J. P., Fahey T. J., 3rd, Lowry S. F., Shires G. T. Bacterial overgrowth and intestinal atrophy in the etiology of gut barrier failure in the rat. Am J Surg. 1991 Feb;161(2):300–304. doi: 10.1016/0002-9610(91)91148-c. [DOI] [PubMed] [Google Scholar]
  4. 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]
  5. Bianchi G., Ferretti P., Recchia M., Rocchetti M., Tavani A., Manara L. Morphine tissue levels and reduction of gastrointestinal transit in rats. Correlation supports primary action site in the gut. Gastroenterology. 1983 Oct;85(4):852–858. [PubMed] [Google Scholar]
  6. Brown N. J., Coupar I. M., Rumsey R. D. The effect of acute and chronic administration of morphine and morphine withdrawal on intestinal transit time in the rat. J Pharm Pharmacol. 1988 Dec;40(12):844–848. doi: 10.1111/j.2042-7158.1988.tb06286.x. [DOI] [PubMed] [Google Scholar]
  7. Burke D. J., Alverdy J. C., Aoys E., Moss G. S. Glutamine-supplemented total parenteral nutrition improves gut immune function. Arch Surg. 1989 Dec;124(12):1396–1399. doi: 10.1001/archsurg.1989.01410120042009. [DOI] [PubMed] [Google Scholar]
  8. 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]
  9. 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]
  10. Edmiston C. E., Jr, Condon R. E. Bacterial translocation. Surg Gynecol Obstet. 1991 Jul;173(1):73–83. [PubMed] [Google Scholar]
  11. Grant J. P., Snyder P. J. Use of L-glutamine in total parenteral nutrition. J Surg Res. 1988 May;44(5):506–513. doi: 10.1016/0022-4804(88)90155-2. [DOI] [PubMed] [Google Scholar]
  12. Grosman N. Histamine release from isolated rat mast cells: effect of morphine and related drugs and their interaction with compound 48/80. Agents Actions. 1981 May;11(3):196–203. doi: 10.1007/BF01967614. [DOI] [PubMed] [Google Scholar]
  13. Güngör M., Genç E., Sağduyu H., Eroğlu L., Koyuncuoğlu H. Effect of chronic administration of morphine on primary immune response in mice. Experientia. 1980 Nov 15;36(11):1309–1310. doi: 10.1007/BF01969606. [DOI] [PubMed] [Google Scholar]
  14. Ling G. S., Paul D., Simantov R., Pasternak G. W. Differential development of acute tolerance to analgesia, respiratory depression, gastrointestinal transit and hormone release in a morphine infusion model. Life Sci. 1989;45(18):1627–1636. doi: 10.1016/0024-3205(89)90272-5. [DOI] [PubMed] [Google Scholar]
  15. Livingston E. H., Passaro E. P., Jr Postoperative ileus. Dig Dis Sci. 1990 Jan;35(1):121–132. doi: 10.1007/BF01537233. [DOI] [PubMed] [Google Scholar]
  16. Lo C. W., Walker W. A. Changes in the gastrointestinal tract during enteral or parenteral feeding. Nutr Rev. 1989 Jul;47(7):193–198. doi: 10.1111/j.1753-4887.1989.tb02837.x. [DOI] [PubMed] [Google Scholar]
  17. Miller M. S., Galligan J. J., Burks T. F. Accurate measurement of intestinal transit in the rat. J Pharmacol Methods. 1981 Nov;6(3):211–217. doi: 10.1016/0160-5402(81)90110-8. [DOI] [PubMed] [Google Scholar]
  18. Souba W. W., Klimberg V. S., Plumley D. A., Salloum R. M., Flynn T. C., Bland K. I., Copeland E. M., 3rd The role of glutamine in maintaining a healthy gut and supporting the metabolic response to injury and infection. J Surg Res. 1990 Apr;48(4):383–391. doi: 10.1016/0022-4804(90)90080-l. [DOI] [PubMed] [Google Scholar]
  19. Spaeth G., Berg R. D., Specian R. D., Deitch E. A. Food without fiber promotes bacterial translocation from the gut. Surgery. 1990 Aug;108(2):240–247. [PubMed] [Google Scholar]
  20. Steffen E. K., Berg R. D. Relationship between cecal population levels of indigenous bacteria and translocation to the mesenteric lymph nodes. Infect Immun. 1983 Mar;39(3):1252–1259. doi: 10.1128/iai.39.3.1252-1259.1983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Weisbrodt N. W., Badial-Aceves F., Copeland E. M., Dudrick S. J., Castro G. A. Small-intestinal transit during total parenteral nutrition in the rat. Am J Dig Dis. 1978 Apr;23(4):365–369. doi: 10.1007/BF01072422. [DOI] [PubMed] [Google Scholar]
  22. Weisbrodt N. W., Badial-Aceves F., Dudrick S. J., Burks T. F., Castro G. A. Tolerance to the effect of morphine on intestinal transit. Proc Soc Exp Biol Med. 1977 Apr;154(4):587–590. doi: 10.3181/00379727-154-39724. [DOI] [PubMed] [Google Scholar]
  23. Weisbrodt N. W., Sussman S. S., Stewart J. J., Burks T. F. Effect of morphine sulfate on intestinal transit and myoelectric activity of the small intestine of the rat. J Pharmacol Exp Ther. 1980 Aug;214(2):333–338. [PubMed] [Google Scholar]
  24. Wells C. L., Maddaus M. A., Simmons R. L. Proposed mechanisms for the translocation of intestinal bacteria. Rev Infect Dis. 1988 Sep-Oct;10(5):958–979. doi: 10.1093/clinids/10.5.958. [DOI] [PubMed] [Google Scholar]
  25. Wilmore D. W., Smith R. J., O'Dwyer S. T., Jacobs D. O., Ziegler T. R., Wang X. D. The gut: a central organ after surgical stress. Surgery. 1988 Nov;104(5):917–923. [PubMed] [Google Scholar]

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