Effect of Starvation, Malnutrition, and Trauma on the Gastrointestinal Tract Flora and Bacterial Translocation

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Abstract
• We have previously shown, In an animal model, that viable indigenous bacteria will cross the intact gastrointestinal (GI) mucosa and spread systemically, a process termed bacterial translocation, if the normal bacterial ecology of the gut was sufficiently disrupted to allow bacterial overgrowth or if the animals were severely immunosuppressed. Starvation or protein malnutrition disrupts the normal indigenous GI tract microflora and impairs host antibacterial defenses. Consequently, we tested the effect of the combination of starvation or protein malnutrition plus burn trauma In promoting bacterial translocation from the GI tract. Bacterial translocation was measured by quantitatively culturing the mesenteric lymph nodes, spleens, livers, blood, and peritoneal cavities of normal or burned (30% of total body surface area) CD1 mice deprived of food for three days or fed a low-protein (0.03%) diet. The effect of starvation or protein mainutrition on the gut microflora was determined by quantitatively measuring the levels of bacteria present In the ceca. Both starvation and protein malnutrition increased the cecal levels of gram-negative enteric bacilli and decreased the levels of lactobacllli and strict anaerobes. Surprisingly, neither starvation nor protein malnutrition promoted bacterial translocation, even though these animals lost over 20% of their body weight and the ecology of the gut microflora was disrupted. In fact, the protein-malnourished animals exhibited lower Incidences of bacterial translocation than normally nourished animals when both groups were monoassociated with Escherlchia coli C-25 or monoassociated and burned. Thus, It appears that protein malnutrition does not promote bacterial translocation, even when combined with burn trauma. (Arch Surg 1987;122:1019-1024)