Altered gut flora are associated with septic complications and death in critically ill patients with systemic inflammatory response syndrome
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Published on: June 15, 2019
Kentaro Shimizu1, Hiroshi Ogura, Toshimitsu Hamasaki
1Department of Clinical Quality Management, Osaka University Hospital, and Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. shimiken@hp-emerg.med.osaka-u.ac.jp
Background:
Gut under severe insult is considered to have an important role in promoting infection and multiple organ dysfunction syndrome from the viewpoint of altered intestinal epithelium, immune system and commensal bacteria. There are few reports, however, about the relationship between gut flora and septic complications.
Methods:
We analyzed gut flora in patients with systemic inflammatory response syndrome (SIRS) and evaluated key bacteria and their cutoff values for infectious complications and mortality by using classification and regression trees (CART). Eighty-one SIRS patients with a serum C-reactive protein level higher than 10 mg/dL treated in the intensive care unit (ICU) for more than 2 days were included for the study. We quantitatively evaluated nine types of bacteria in fecal samples by plate or tube technique. Two hundred seventy-one samples were analyzed using CART and logistic regression.
Results:
The dominant factors for complication of enteritis were the minimum number of total obligate anaerobes and the maximum number of Staphylococcus and Enterococcus. The dominant factors for complication of bacteremia were the minimum numbers of total obligate anaerobes and total facultative anaerobes. The dominant factors for mortality were the numbers of total obligate anaerobes and total facultative anaerobes and age.
Conclusions:
A decrease in total obligate anaerobes and an increase in pathogenic bacteria in the gut are associated with septic complications and mortality in patients with SIRS. The altered gut flora may be a potential prognostic marker in SIRS patients.
Insights
Altered gut flora, with fewer obligate anaerobes and more pathogens, is linked to septic complications and mortality in patients with systemic inflammatory response syndrome (SIRS). This gut dysbiosis may serve as a prognostic marker.
Area of Science:
- Microbiology
- Critical Care Medicine
- Gastroenterology
Background:
- The gut plays a critical role in infection and multiple organ dysfunction syndrome following severe insult.
- Altered intestinal epithelium, immune response, and commensal bacteria contribute to this process.
- Limited research exists on the specific relationship between gut flora and septic complications.
Purpose of the Study:
- To investigate the association between gut microbiota composition and septic complications in patients with systemic inflammatory response syndrome (SIRS).
- To identify key bacterial indicators and their thresholds for predicting infectious complications and mortality in SIRS patients.
Main Methods:
- Quantitative analysis of nine bacterial types in fecal samples from 81 SIRS patients.
- Utilized classification and regression trees (CART) and logistic regression for data analysis.
- Included patients with C-reactive protein > 10 mg/dL in the ICU for over 2 days.
Main Results:
- Reduced total obligate anaerobes and increased Staphylococcus and Enterococcus were associated with enteritis.
- Lower counts of total obligate and facultative anaerobes correlated with bacteremia.
- Gut flora composition (obligate and facultative anaerobes) and age were dominant factors for mortality.
Conclusions:
- Decreased obligate anaerobes and increased pathogenic bacteria in the gut are linked to septic complications and mortality in SIRS.
- Altered gut flora composition shows potential as a prognostic biomarker for SIRS patients.
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