Postinjury shock and early bacteremia. A lethal combination
F. A. Moore, E. E. Moore, R. S. Poggetti and R. A. Read
Department of Surgery, General Hospital Denver, CO 80204-4507.
Gut bacteria translocation has been invoked as a prime cause of early
postinjury death. To examine this hypothesis, we obtained emergency
department blood cultures in 132 acutely injured patients requiring urgent
laparotomy for trauma. In the latter half of these patients, mesenteric
lymph node and liver biopsy cultures were also performed. The incidence of
early bacteremia was 11% (10/94) in the patients without shock compared
with 32% (12/38) in the group with shock. The majority (73%) were
gram-positive bacteremias. Most notably, Staphylococcus was isolated in 13%
(5/38) of the patients with shock, but these isolates were of no apparent
clinical significance. In contrast, 18% (7/38) of the patients with shock
had enteric bacteremias, and all of these patients died. Cultures were
positive in 11% of the liver samples and 15% of the mesenteric lymph nodes.
With the exception of two patients with concurrent enteric bacteremias,
these hepatic and mesenteric lymph node bacteria were of no clinical
significance. In conclusion, bacterial translocation occurs infrequently,
and virtually all enteric bacteria were found in dying patients; the cause
or effect remains to be defined.
