The role of nutrition and drugs in preventing bacterial translocation and associated systemic infections

The addition of pharmacologic amounts of arginine or glutamine to balanced diets, as well as substitution of Omega-3 fdr Omega-6 fatty acids, will independently result in improved resistance to infection and/or enhanced gut barrier function to translocation of intestinal microbes. Combinations of these immunonutrients in diets have further beneficial effects. There are now 7 prospective randomised clinical trials of the use of immunonutrient enriched diets in surgical patients. In the aggregate, these have shown that the use of such diets can reduce wound complications and infection by 50-75% and hospital stay by 20%, also providing considerable economic savings. However, in individuals who have established sepsis with or without multiple system organ failure (MSOF), aggressive feeding may be harmful. In animal studies, high protein diets (20% of energy) and the same dietary formulas that improve resistance to infection in normal animals will often have adverse effects because they may serve as a substrate for bacterial growth in the intestine, support excessive cytokine synthesis by intestinal cells, and increase the amount of bacterial translocation from the intestine. The role of specific immunonutrients in disease is complex. Their influence in regulation of immune responses via interactions with chemotherapeutic agents are largely unknown but worthy of intensive research.