Altered Gut Flora Are Associated with Septic Complications and Death in Critically Ill Patients with Systemic Inflammatory Response Syndrome

Abstract

BackgroundGut 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.MethodsWe 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.ResultsThe 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.ConclusionsA 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.

Dangerous Disappearing Act: Commensal Gut Microbiota After Acute Severe Insults

“…This Janus-faced characteristic of the gut microbiota resembles the immune system itself, a powerful defense that can turn on its host. Altered gut microflora is involved in the pathogenesis of a wide variety of diseases, including metabolic syndrome, obesity, congestive heart failure, pancreatitis, inflammatory bowel disease, and critical illness [1][2][3][4]. As Hayakawa et al point out in this issue of Digestive Diseases and Sciences, the gut microbiota is also dramatically changed in acute trauma, out-of-hospital cardiac arrest, and cerebrovascular disease [5].…”

“…Most studies of gut microbiota in critical illness have examined hospitalized patients receiving intensive care [4,6]. Shimizu et al have shown that the gut microbiota is significantly altered in patients with systemic inflammatory response syndrome (SIRS) [4,6].…”

“…Shimizu et al have shown that the gut microbiota is significantly altered in patients with systemic inflammatory response syndrome (SIRS) [4,6]. Until now, the timing of changes in gut ecology has been unknown.…”

“…Observational studies suggest a link between the preservation of gut microbiota and survival during critical illness [4]. Shimizu et al reported that gut flora depletion, and loss of obligate anaerobes in particular, increases the risk of gut-derived sepsis, enteritis, and mortality [4,9].…”

“…Shimizu et al reported that gut flora depletion, and loss of obligate anaerobes in particular, increases the risk of gut-derived sepsis, enteritis, and mortality [4,9]. Changed gut flora and impaired intestinal barrier function are thought to promote the movement of endotoxin and gut bacteria into the portal circulation and gut lymphatics [7].…”