The relationship between gut-derived bacteria and the development of the multiple organ dysfunction syndrome.

Abnormal colonisation, infections of gut origin and bacterial translocation are all signs of gut failure that have been hypothesised as being implicated in the pathogenesis of the multiple organ dysfunction syndrome (MODS). We have summarised published experimental and clinical studies that have tried to correlate the occurrence or prevention of these phenomena with the development of MODS. We conclude that in some patients loss of intestinal barrier function or the onset of infection precedes the development of MODS. In other patients, however, this relationship is not so clear and it seems that these are epiphenoma of critical illness and may reflect a failure of the host's immune and mechanical defence systems. The causal relationship between these phenomena and the development of MODS is complex and needs further clarification.