Sepsis without focus: Clinical relevance of bacterial translocation

The passage of bacteria, fungi, and bacterial products through the gut wall, which is called microbial translocation, is an experimentally well-defined process occurring during burn injury, multiple trauma, and septic diseases. The translocation of viable bacteria could be demonstrated in humans as a sporadic event, but despite accumulating evidence the clinical relevance remains to be elucidated. The same fact is true for the translocation of bacterial products such as endotoxin. Although a large body of evidence supports the hypothesis that endotoxin of gut origin may play a pathophysiologically important role, general acceptance is still lacking because some clinical studies provide disappointing results due to unrecognized methodological problems.