SBP is caused by translocation of gastrointestinal organisms into the ascitic fluid, most commonly Escherichia coli, Klebsiella pneumoniae and Streptococcus pneumoniae.
This concern is based on studies of animal models that describe the translocation of gut organisms across intestinal mucosa with enhanced permeability.
Likewise, translocation of gut organisms, such as vancomycin-resistant enterococci (VRE), may cause bacteraemia and, ultimately, sepsis in neutropenic cancer patients in up to 40%% of colonized patients [ 30, 101, 154].
In addition, the epithelial barrier function is impaired, with a consequent increase in gastrointestinal permeability, and a potential predisposition to translocation of enteric organisms, systemic infection and, hence, adverse outcomes [ 11, 13].
However, it is also possible that the surgical trauma could have facilitated the translocation of these organisms to the bloodstream – in this case, gastrointestinal surgery is to be an independent risk factor for candidaemia in patients with solid tumours.
An increase in gut permeability allows the translocation of micro-organisms into the bloodstream with bacteraemia or candidaemia.
This translocation is supported by the fact that 75% of 32 patients had certain gastrointestinal symptoms or disorders, which may predispose to CDB either by direct extension through perforation or by promoting translocation of the organism across the intestinal wall (10 ).
Although selective gut decontamination and, to some extent, enteral nutrition were shown to decrease infectious complications [ 19, 20], no specific agent that can strengthen the gut barrier or inhibit translocation of micro-organisms from the gut lumen has yet been identified.
Also, endotoxemia can result from translocation of Gram-negative organisms and/or endotoxin from the terminal ileum and cecum in the setting of gastrointestinal tract mucosal barrier dysfunction that has been observed during hypoperfusion of the gastrointestinal tract [ 8].
Contamination of necrotic tissues occurs primarily because of translocation of enteric micro-organisms [ 27].
