Bacterial translocation following intrabdominal surgery. Any influence of antimicrobial prophylaxis?

Bacterial translocation may accompany various intra-abdominal operations. In order to define its incidence and the effect of preoperative antimicrobial prophylaxis and the duration of hospitalization before elective surgery, mesenteric lymph nodes were excised from 43 patients undergoing various programmed intra-abdominal operations without any evidence of intra-abdominal septic focus. Nodes were cultured and examined for histopathological findings of reactive lymphadenitis. The incidence of bacterial translocation was 5.9% accompanying graft replacement post aortic aneurysm, 44.4% accompanying colectomy, 50% accompanying gastrectomy and 33.3% accompanying splenectomy but it did not occur with other types of laparotomy. Bacterial isolates from the mesenteric lymph nodes were mainly species of enterobacteriaceae. Bacterial translocation was found in 17.6% of patients receiving antimicrobial prophylaxis prior to dissection of the lymph nodes compared with 26.8% of those administered prophylaxis after lymph node removal (PNS). Reactive lymphadenitis was documented in 70.6% of patients undergoing aortic aneurysm graft replacement, in 33.3% undergoing colectomy, in 50% undergoing gastrectomy, in 33.3% undergoing cholocystectomy (33.3%) whereas it was not found in any patient undergoing splenectomy or other type of laparotomy. It is concluded that colectomy and gastrectomy are accompanied by the greatest risk for bacterial translocation among a great variety of intra-abdominal operations. The administration of preoperative antimicrobial prophylaxis and the duration of hospitalization before operation did not seem to have any effect on the process of bacterial translocation. Copyright 2002 Elsevier Science B.V. and International Society of Chemotherapy