Traslocazione batterica e sua rilevanza chirurgica.

The passage of viable bacteria through epithelial mucosa into lamina propria and then to mesentheric lymphnodes, and possibly other tissues was defined bacterial translocation (BT) by Berg and Garlington. The transepithelial passage of bacteria out of the intestinal lumen seems to occur in a variety of surgical conditions, and it is suspected to be involved in systemic inflammatory response syndrome, sepsis and multiorgan failure. There is increasing evidence that many nosocomial infections are caused by enteric translocating microorganisms, although the exact incidence of BT in humans is difficult to establish. Consensus is emerging that the barrier function of the gut is relevant in established critical illness and in patients at risk of developing sepsis and clinical studies have provided strong evidence that systemic infections often originate from intestinal flora in high risk patients. So the suspect of BT is made when there is infection after trauma, burns, major surgery, chemotherapy and immuno suppression. Bacterial translocation is also associated with organ transplantation, especially with small bowel transplantation. The Authors have summarized published experimental and clinical studies that have tried to understand the occurrence, mechanisms and effects of this complex process. At the present time there is a near full understanding of the relevance of BT like an interplay of diverse factors in a physiologically, immunologically and microbiologically complex intestinal tract. However additional experimental and clinical studies are needed to clarify the relationship between these phenomena and the development of sepsis or multiple organ dysfunction syndrome.