Effects of starvation and haemorrhage on the large bowel coliform flora with special reference to bacterial mucosal adherence and translocation
Author: Nettelbladt, Carl-Gustaf
Date: 1998-01-09
Location: Kirurgiska klinikens föreläsningssal, plan 4, Karolinska sjukhuset
Time: 9.00
Abstract
Effects of starvation and haemorrhage on the large bowel coliformflora
with special reference to bacterial mucosal adherence and translocation
by Carl-Gustaf Nettelbladt, MD Department of Surgery, Karolinska Hospital
andInstitute, S-171 76 Stockholm, Sweden
Intestinal bacteria translocating to extraintestinal sites have been
suggestedto play a role in the etiology of posttraumatic infections and
multiple organ failure.In the present study, effects of haemorrhagic
stress and /or starvation on the gutflora and bacterial translocation
were studied in the rat.
Hyperosmotic glucose infusion dunng haemorrhage in starved rats improved
plasmarefill but did not reduce bacterial translocation. In this
experiment four groupsof rats were subjected to haemorrhage. Two groups
were given an i.v.infusion of hyperosmoticglucoseduring moderate
(38%bloodloss;n=12) or severe (43%bloodloss; n=19) haemorrhage
withoutreinfusion. Control groups received an i.v. infusion of saline
during moderate (n=12)or severe (n=18) haemorrhage. No difference in
bacterial translocation was observedbetween groups infused with glucose
or saline.
Starvation increased the number of coliform bacteria in caecal contents
and inducedadherence of coliform bacteria to caecal epithelium. Rats in a
control group (n=19)were given their regular food. Six rats were starved
for 24 hours and another 15for 48 hours, with free access to water. Six
rats underwent non-lethal haemorrhage(mean arterial pressure=55 mm Hg).
These animals were only allowed water until sampling24 hours later.
Twentyfour hours starvation increased the number of bacteria in
caecalcontents 25-fold (p<0.05). 48 hours starvation further increased
the number (p<0.001)and induced a marked increase in bacteria adherent to
caecal epithelium (p<0.001).In the haemorrhaged group similar changes
were observed and bacterial translocationincreased (p<0.05) as compared
to control rats.
In order to characterise and compare coliform bacteria in caecal
contents, oncaecal epithelium and in mesenteric Iymph nodes of 57 rats
subjected to differentdegrees of stress a biochemical finger printing
method was used. A total of 291 biochemicalphenotypes were found in
caecal contents of all rats. Out of these, 108 were detectedon caecal
epithelium and only 19 of these appeared in mesenteric Iymph nodes of
thecorresponding rat. A total of 36 biochemical phenotypes were found in
mesentericIymph nodes of all rats. Twentyone of these belonged to four
common phenotypes. Theprevalence of these four phenotypes in mesenteric
Iymph nodes did not differ significantly,while some of them had a low and
some a high prevalence in caecal contents and oncaecal epithelium. The
phenotypes found in mesenteric Iymph nodes were also, mostly,found
adherent to the caecal epithelium of the corresponding rat.
Orally inoculated translocating strains of E. coli were able to colonise
the gut.Thus, inoculation increased bactenal translocation in rats
lacking these strainsin their indigenous gut flora. Two groups of rats
were inoculated with two translocatingstrains of E. coli. One group (n=l
l ) was starved for 24 hours and the other (n=20)underwent non-lethal
haemorrhage (mean arterial pressure=50 mm Hg) and was starvedfor 24 hours
thereafter. Two non-inoculated groups of similar size, subjected tothe
same treatments served as controls. In the inoculated groups, bacterial
translocationincreased both after 24 hours starvation (p<0.05) and
haemorrhage (p<0.01)as compared to non-inoculated control rats.
Ingestion of bulking fibre prevented mucosal adherence and translocation
of atranslocating strain of E. coli. Four groups of rats were inoculated
with a translocatingstrain of E coli. Animals in a control group (n=8)
were given their regular food.Eight rats were starved for 48 hours and
eight given only bulking fibre for 48 hours.An additional group (n=8)
ingested bulking fibre only for 24 hours before and afterhaemorrhage
(mean arterial pressure=50 mm Hg). Bulking fibre for 48 hours reducedboth
mucosal adherence (p<0.05) and translocation (p<0.001) of the
inoculatedbacteria as compared to starved rats.
It is concluded that haemorrhagic stress and starvation have marked
effects onthe gut flora. Glucose infusion given during haemorrhage,
previously shown to protectthe animal during circulatory shock, can not
prevent bacterial translocation. Briefstarvation increases the number of
coliform bacteria in caecum and induces bacterialmucosal adherence. Only
a limited number of strains of coliform bacteria translocateafter stress.
Adherence to caecal epithelium was associated with bacterial
translocation.Inoculation with translocating strains of E. coli increases
bacterial translocation.Bulking fibre prevents bacterial mucosal
adherence and translocation. Detailed knowledgeof the gut E. coli flora
is of great importance when interpreting results of studieson bactenal
translocation.
Key words: Bacterial translocation, plasma refill, starvation,
haemorrhage, coliforms,Escherichia coli, biochemical fingerprinting,
bulking fibre.
ISBN 91-628-2783-9 Stockholm 1998
Issue date: 1997-12-19
Publication year: 1998
ISBN: 91-628-2783-9
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