| In 1970' , some savants demonstrated the theories of * translocation of enter-obacteria' and Intestinal endotoxin'. From then on , the effect of gastro - intestinal tract in the occurrence and development of systemic inflammatory response syndrome ( SIRS) became the focus of medical research. To investigate the bacterial translocation from intestine and the change of gastric fluid microbial population and hemoculture during the development of SIRS by reviewing the results of gastric fluid bacterial culture of the children with severe SIRS, and to grasp the principle of the change of gastric fluid microbial population in children suffering severe SIRS, provide theoretical bases for clinic.Materials and MethodsTo select the 43 inpatient cases of severe SIRS children in the pediatric intensive care unit ( PICU) of the second affiliated hospital of China Medical University from Jan, 2002 to Dec, 2002 (severe SIRS group). The twenty children that were suffering the popular type pneumonia and consistent with the diagnosis of early SIRS in the same period were made as control group ( early SIRS group ). After hospitalization, we collected the gastric fluid and blood of the patients, carried out bacterial culture individually.ResultsThe positive rate of gastric fluid bacterial culture of the severe SIRS group was 44.2% (19/43) , 10 cases were Klebsiella pneumoniae, 3 cases were en-terococci, 2 cases were Candida alba . The rest 4 cases were Pseudomonas mal-tophilia, yeast - like fungus, Staphylococcus epidermidis and Streptococcus viri-dans invidivually. The ratio of Klebsiella pneumoniae was 52. 6% ( 10/19 ). The positive rate of hemoculture was 23.3% (10/43) , 3 cases were escherichia coli, 2 cases were meningococcus. The rest 5 cases were uncertainties mini -coccobacteria, Salmonella typhi, Pseudomonas cepacia , Bacillus cholerae - su-is and anti - digest subspecies of beech wood sugar Bacillus alcaligenes individually. The ratio of enterobacter was sixty percent. The result of gastric fluid bacterial culture was significantly different between the severe SIRS group and the early SIRS group (P <0.01) , and the of hemoculture was different between the severe SIRS group and the early SIRS group ( P < 0. 05 ). The positive rate of gastric fluid bacterial culture of the infant smaller than six month was 61. 9% (13/21) , and that of hemoculture was 19. 0% (4/21). In the severe SIRS group, the positive rate of gastric fluid bacterial culture of the patient in the intermediate stage of SIRS was 32. 0% ( 8/25 ) , and that of hemoculture was 8.0% (2/25 ) ; the positive rate of gastric fluid bacterial culture of the patient in the advanced stage of SIRS was 61. 1% (11/18) , and that of hemoculture was 44.4% (8/18). About thirty percent of strain produced extended spectrum B lactamases ( ESBLS).DiscussionWe can diagnosis and treat earlier if we grasp the principle of the intestinal tract microbial population change, remove the potential cause of the transloca-tion of enterobacteria and endotoxin, terminate the development of disease. In this way, we can inhibit or relive the bulk release of mediators of inflammation, prevent the onset of MODS, decrease the case fatality rate of SIRS children.Conclusions1. Before the translocation of enterobacteria and endotoxin and the onset of multiple organ dysfunction syndrome (MODS) , there were severe imbalance ofgastrointestinal tract microbial population in gastrointestinal tract in the severe SIRS children. During this period, the positive rate of gastric fluid bacterial culture was higher than that of hemoculture, especially in the infant smaller than six month.2. The main translocated bacteria were inherent entero - permanent planting population and conditional pathogenic bacteria.3. The sepsis syndrome of SIRS children may be related to the bacteria translocation of gastrointestinal tract.4. The thirty percent strain that produced ESBLs was resistant to most antibiotics except Tienam and Mepem. So there is troublesome in clinical therapy. |
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