Early in 1962, after an extensive review including 312 cases of
bacteremia in
burn patients, we were surprised to find that there was about 30% of
bacteremia in the patients who had no detectable microorganisms from repeated
wound cultures, but blood cultures were usually positive for gut flora. From that time on the idea of gut-origin
infection emerged. In following twenty years, a series of experiments were carried on in Wistar rats with 30% TBSA full-thickness
burn. The results showed that the
fluorescein labeled enteric microbes (Pseudomonas aeruginosa, Bacteroid fragilis and Candida albicans) could translocate through the stress injured intestinal wall and were recovered in visceral organs. The
radioisotope 125I labeled
endotoxin began to ascend in concentration in portal vein since 15 minutes postburn. Radioautography of liver sections demonstrated the labeled
endotoxin granules. With the creation of minute mesenteric lymph
fistulas, the clearance of
endotoxin and
TNFalpha was found to be significantly high in lymph fluid exited from the intestine. All above evidences indicated that the gut is a potential route of endogenous
infection, and it also explained how did the patients manifest
sepsis early after
burn injury without a definite infectious focus. Now the concepts of gut-origin
infection are commonly accepted, the measures like early
enteral feeding for the protection of intestinal barrier has been established.