Bacterial translocation from the gut complicating hemorrhagic shock

ABSTRACT

To determine whether hemorrhagic shock would promote bacterial translocation from the gut to visceral organs, rabbits were subjected to a model of hemorrhagic shock [mean pressure, 30 mm/Hg]. Twenty- four hours after being subjected to sham-shock, or 90 minutes of shock, rabbits were sacrificed and their organs quantitatively cultured for translocating bacteria. There was a direct relationship between the duration of hemorrhagic shock and the 24-hours mortality rate. Bacteria did not translocate from the gut in the sham-shock rabbits, but translocated to the mesenteric lymph nodes, livers and spleens of the rabbits subjected to hemorrhagic shock. Rabbits subjected to 90 minutes of shock exhibited a greater degree of bacterial translocation than rabbits receiving 30 or 60 minutes of shock; whereas the incidences of translocation were significantly [P < 0.01 and P < 0.001] increased with the increase of duration of hemorrhagic shock. The most common translocating bacteria were Escherichia coli and Enterococcus. Hemorrhagic shock produced subepithelial edema and focal areas of necrosis in the ileum, vacuolization of the renal epithelial cells with cellular debris within the renal tubules, and hepatic centrilobular venous congestion. Thus hemorrhagic shock followed by reinfusion of shed blood disrupts the gut barrier and allows indigenous bacteria normally contained within the gut to cause systemic infections