PRUPOSE: Bacterial translocation has been shown to occur in critically ill patients after extensive trauma, shock, sepsis, or thermal injury. The present study investigates mesenteric microcirculatory dysfunctions, the bacterial translocation phenomenon, and hemodynamic/metabolic disturbances in a rat model of intestinal obstruction and ischemia. METHODS: Anesthetized (pentobarbital 50 mg/kg, i.p.) male Wistar rats (250-350 g) were submitted to intestinal obstruction or laparotomy without intestinal obstruction (Sham) and were evaluated 24 hours later. Bacterial translocation was assessed by bacterial culture of the mesenteric lymph nodes (MLN), liver, spleen, and blood. Leukocyte-endothelial interactions in the mesenteric microcirculation were assessed by intravital microscopy, and P-selectin and intercellular adhesion molecule (ICAM)-1 expressions were quantified by immunohistochemistry. Hematocrit, blood gases, lactate, glucose, white blood cells, serum urea, creatinine, bilirubin, and hepatic enzymes were measured. RESULTS: About 86% of intestinal obstruction rats presented positive cultures for E. coli in samples of the mesenteric lymph nodes, liver, and spleen, and 57% had positive hemocultures. In comparison to the Sham rats, intestinal obstruction induced neutrophilia and increased the number of rolling (~2-fold), adherent (~5-fold), and migrated leukocytes (~11-fold); this increase was accompanied by an increased expression of P-selectin (~2-fold) and intercellular adhesion molecule-1 (~2-fold) in the mesenteric microcirculation. Intestinal obstruction rats exhibited decreased PaCO2, alkalosis, hyperlactatemia, and hyperglycemia, and increased blood potassium, hepatic enzyme activity, serum urea, creatinine, and bilirubin. A high mortality rate was observed after intestinal obstruction (83% at 72 h vs. 0% in Sham rats). CONCLUSION: Intestinal obstruction and ischemia in rats is a relevant model for the in vivo study of mesenteric microcirculatory dysfunction and the occurrence of bacterial translocation. This model parallels the events implicated in multiple organ dysfunction (MOD) and death.

Os antibióticos são comumente utilizados para melhorar uma infecção estabelecida e possuem a finalidade de eliminar ou impedir o crescimento bacteriano. Os riscos mais importantes relacionados ao seu uso são: reações adversas, resistência bacteriana e possíveis interações medicamentosas. Foram realizadas entrevistas com os pacientes para observar o entendimento dos mesmos sobre o uso do antibiótico e tratamento. 38,3% dos pacientes são menores de 18 anos e a maioria é do sexo feminino. Um terço não compreende diagnóstico ou posologia e a maioria consultou-se com um clínico geral. Ainda há resistência na prescrição do nome genérico. Cerca de 8% das receitas continham interação medicamentosa. Grande parte dos tratamentos pode estar comprometida pelo não entendimento do paciente ou presença de interação medicamentosa. A eficácia do tratamento depende de todos os profissionais de saúde, sendo necessário treinamento a esses profissionais tanto para conhecimento próprio quanto para atenção farmacêutica.

The use of antibiotics in the treatment of established infections for inhibiting or abolishing the growth of microorganism is very common. The risks related to their use include side effects, drug resistance and potential drug-drug interactions. A structured questionnaire was applied to patients in order to collect information about their understanding of the treatment and of how to use the antibiotic. As to the profile of the patients, 38.3% are younger than 18 years and most are females. One third does not understand the diagnosis or prescribed dosage and most of the patients had consulted with the general practitioner. Prescriptions of generic drugs continue rare, probably due to the physicians' resistance to prescribe this kind of medication. About 8% of prescriptions involved drug-drug interactions. Many treatments are compromised due to the lack of information provided to the patient or to drug-drug interactions. The efficiency of a treatment depends on all health professionals involved, who need to be adequately trained for providing effective pharmacy care.

Os antibióticos são comumente utilizados para melhorar uma infecção estabelecida e possuem a finalidade de eliminar ou impedir o crescimento bacteriano. Os riscos mais importantes relacionados ao seu uso são: reações adversas, resistência bacteriana e possíveis interações medicamentosas. Foram realizadas entrevistas com os pacientes para observar o entendimento dos mesmos sobre o uso do antibiótico e tratamento. 38,3% dos pacientes são menores de 18 anos e a maioria é do sexo feminino. Um terço não compreende diagnóstico ou posologia e a maioria consultou-se com um clínico geral. Ainda há resistência na prescrição do nome genérico. Cerca de 8% das receitas continham interação medicamentosa. Grande parte dos tratamentos pode estar comprometida pelo não entendimento do paciente ou presença de interação medicamentosa. A eficácia do tratamento depende de todos os profissionais de saúde, sendo necessário treinamento a esses profissionais tanto para conhecimento próprio quanto para atenção farmacêutica.

The use of antibiotics in the treatment of established infections for inhibiting or abolishing the growth of microorganism is very common. The risks related to their use include side effects, drug resistance and potential drug-drug interactions. A structured questionnaire was applied to patients in order to collect information about their understanding of the treatment and of how to use the antibiotic. As to the profile of the patients, 38.3% are younger than 18 years and most are females. One third does not understand the diagnosis or prescribed dosage and most of the patients had consulted with the general practitioner. Prescriptions of generic drugs continue rare, probably due to the physicians' resistance to prescribe this kind of medication. About 8% of prescriptions involved drug-drug interactions. Many treatments are compromised due to the lack of information provided to the patient or to drug-drug interactions. The efficiency of a treatment depends on all health professionals involved, who need to be adequately trained for providing effective pharmacy care.