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Effects of sepsis and its treatment measures on intestinal flora structure in critical care patients
Xiao-Juan Yang1, Dan Liu2, Hong-Yan Ren3
1Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China.
Background:
Sepsis is a common disease in intensive care units, with high morbidity and mortality. Intestinal microecology plays a vital part in the development and progression of this disease, possibly because sepsis and its treatment cause specific changes in the composition of the intestinal flora.
Aim:
To investigate the characteristics of intestinal flora disturbance in sepsis patients treated with antibiotics.
Methods:
In this prospective comparative study, we enrolled ten patients with sepsis (sepsis group), hospitalized in the Department of Critical Care Medicine of the General Hospital, Ningxia Medical University, China (a class IIIa general hospital) from February 2017 to June 2017; ten patients without sepsis hospitalized in the same period (non-sepsis group) and ten healthy individuals (control group) were also enrolled. Fecal samples collected from the three groups were subjected to 16S rRNA gene sequencing and the intestinal flora diversity, structure, and composition were determined. Additionally, the dynamics of the intestinal flora diversity, structure, and composition in sepsis patients were investigated via 16S rRNA gene sequencing of samples collected 0 d, 3 d, and 7 d after admittance to the intensive care unit. Correlations between the serum levels of procalcitonin, endotoxin, diamine oxidase, and D-lactic acid and the intestinal flora composition of sepsis patients were also investigated.
Results:
Compared with the healthy control group, sepsis and non-sepsis patients showed reduced intestinal flora α-diversity and a distinct flora structure, with Firmicutes as the dominant phylum, and significantly decreased proportions of Bacteroidetes, as well as Prevotella and Lachnospira, among other genera. Of note, the proportion of Enterococcus was significantly increased in the intestinal tract of sepsis patients. Interestingly, the α-diversity in the sepsis group decreased gradually, from days 1 to 7 of treatment. However, pairwise comparisons showed that both the diversity and structure of the intestinal flora were not significantly different considering the three different time points studied. Curiously, the serum levels of procalcitonin, endotoxin, diamine oxidase, and D-lactic acid in sepsis patients correlated with the prevalence of various bacterial genera. For example, the prevalence of Ruminococcus was positively correlated with serum procalcitonin, endotoxins, and diamine oxidase; similarly, the prevalence of Roseburia was positively correlated with serum procalcitonin, endotoxins, and D-lactic acid.
Conclusion:
Sepsis patients in intensive care units show dysbiosis, lasting for at least 1 wk.
Insights
Sepsis patients exhibit significant intestinal flora dysbiosis, characterized by reduced diversity and altered composition, which persists for at least one week. This gut microbiome imbalance correlates with key sepsis biomarkers.
Area of Science:
- Microbiology
- Critical Care Medicine
- Gastroenterology
Background:
- Sepsis is a life-threatening condition common in intensive care units (ICUs), associated with high mortality rates.
- Intestinal microecology is increasingly recognized for its role in sepsis development and progression.
- Antibiotic treatments for sepsis can significantly alter the gut flora composition.
Purpose of the Study:
- To investigate the specific characteristics of intestinal flora disturbance in sepsis patients receiving antibiotic treatment.
- To analyze changes in gut microbiome diversity, structure, and composition over time in ICU sepsis patients.
- To explore correlations between serum biomarkers and intestinal flora in sepsis.
Main Methods:
- Prospective comparative study involving sepsis patients, non-sepsis patients, and healthy controls.
- 16S rRNA gene sequencing of fecal samples to determine gut flora diversity and composition.
- Analysis of flora dynamics at 0, 3, and 7 days post-ICU admission and correlation with serum procalcitonin, endotoxin, diamine oxidase, and D-lactic acid levels.
Main Results:
- Sepsis and non-sepsis patients showed reduced alpha-diversity and distinct flora structure compared to controls, with decreased Bacteroidetes and increased Enterococcus.
- Gut microbiome alpha-diversity in sepsis patients gradually decreased during the first week of treatment.
- Serum biomarkers (procalcitonin, endotoxin, etc.) in sepsis patients showed significant correlations with the prevalence of specific bacterial genera like Ruminococcus and Roseburia.
Conclusions:
- Sepsis patients in ICUs experience significant gut dysbiosis.
- This intestinal flora imbalance, or dysbiosis, persists for at least one week.
- The study highlights the link between gut microbiome alterations and sepsis severity markers.
