The gut microbiota of critically ill patients: first steps in an unexplored world

Ruppé, Étienne; Lisboa, Thiago; Barbier, François

doi:10.1007/s00134-018-5309-3

Cited by 20 publications

(15 citation statements)

References 20 publications

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“…Of special note, the presence of specific pathogens at ICU admission was associated with subsequent infection with the same organism for Escherichia coli, Pseudomonas spp., Klebsiella spp., Clostridium difficile , and vancomycin-resistant Enterococcus (66). Furthermore, Enterococcus status at ICU admission was associated with risk for death or all-cause infection, indicating that the gut microbiota alterations have potential impact on mortality or the risk of healthcare-associated infections in critically ill patients (67). The patients with SAP also had significant alterations in the gut microbiota, including reduced microbiota diversity, increased Enterococcus and Enterobacteriaceae , and decreased Bifidobacterium (68).…”

Section: Dysbiosis Of Intestinal Microbiota and Gut-derived Infectionmentioning

confidence: 99%

Microbiota-Immune Interaction in the Pathogenesis of Gut-Derived Infection

2019

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Gut-derived infection is among the most common complications in patients who underwent severe trauma, serious burn, major surgery, hemorrhagic shock or severe acute pancreatitis (SAP). It could cause sepsis and multiple organ dysfunction syndrome (MODS), which are regarded as a leading cause of mortality in these cases. Gut-derived infection is commonly caused by pathological translocation of intestinal bacteria or endotoxins, resulting from the dysfunction of the gut barrier. In the last decades, the studies regarding to the pathogenesis of gut-derived infection mainly focused on the breakdown of intestinal epithelial tight junction and increased permeability. Limited information is available on the roles of intestinal microbial barrier in the development of gut-derived infection. Recently, advances of next-generation DNA sequencing techniques and its utilization has revolutionized the gut microecology, leading to novel views into the composition of the intestinal microbiota and its connections with multiple diseases. Here, we reviewed the recent progress in the research field of intestinal barrier disruption and gut-derived infection, mainly through the perspectives of the dysbiosis of intestinal microbiota and its interaction with intestinal mucosal immune cells. This review presents novel insights into how the gut microbiota collaborates with mucosal immune cells to involve the development of pathological bacterial translocation. The data might have important implication to better understand the mechanism underlying pathological bacterial translocation, contributing us to develop new strategies for prevention and treatment of gut-derived sepsis.

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Section: Dysbiosis Of Intestinal Microbiota and Gut-derived Infectionmentioning

confidence: 99%

Microbiota-Immune Interaction in the Pathogenesis of Gut-Derived Infection

2019

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“…antibiotics, insertion of feeding tubes, surgery, etc.). 11,12 The changes in the IM diversity of critically ill patients after ICU admission seem to combine a reduction in strict anaerobes and increase in pathogenic species, thus associated with an increased mortality. 3,13 Furthermore, a previous report indicated that prolonged critical illness in ICU patients produces profound alterations in the structure of the IM leading to the microbial diversity vanishing to almost-null levels, with concomitant boosting of the virulence of those ultra-low diversity communities by opioid and antibiotic administration.…”

Section: Introductionmentioning

confidence: 99%

Gut microbiota profiles in critically ill patients, potential biomarkers and risk variables for sepsis

et al. 2020

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Critically ill patients are physiologically unstable and recent studies indicate that the intestinal microbiota could be involved in the health decline of such patients during ICU stays. This study aims to assess the intestinal microbiota in critically ill patients with and without sepsis and to determine its impact on outcome variables, such as medical complications, ICU stay time, and mortality. A multi-center study was conducted with a total of 250 peri-rectal swabs obtained from 155 patients upon admission and during ICU stays. Intestinal microbiota was assessed by sequencing the V3-V4 hypervariable regions of the 16S rRNA gene. Linear mixed models were used to integrate microbiota data with more than 40 clinical and demographic variables to detect covariates and minimize the effect of confounding factors. We found that the microbiota of ICU patients with sepsis has an increased abundance of microbes tightly associated with inflammation, such as Parabacteroides, Fusobacterium and Bilophila species. Female sex and aging would represent an increased risk for sepsis possibly because of some of their microbiota features. We also evidenced a remarkable loss of microbial diversity, during the ICU stay. Concomitantly, we detected that the abundance of pathogenic species, such as Enterococcus spp., was differentially increased in sepsis patients who died, indicating these species as potential biomarkers for monitoring during ICU stay. We concluded that particular intestinal microbiota signatures could predict sepsis development in ICU patients. We propose potential biomarkers for evaluation in the clinical management of ICU patients.

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“…Well-designed studies remain warranted to definitely address several aspects of this issue, notably the clinical input of rapid diagnostic tools and TDM, the potential benefit of combination versus single-drug therapies, the optimal dosing regimens before the availability of AST results or for patients with culture-negative sepsis, and the prognostic yield of ASP. Although beyond the scope of this review, the exploitation of other research axes may further help to control the spread of MDRB in the ICU setting, including optimization of infection control policies [167], a comparative appraisal of the impact of broad-spectrum antibiotics on the gut microbiota through novel metagenomics approaches [168], and the evaluation of emerging options such as orally administered antimicrobial-adsorbing charcoals, probiotics, or fecal microbiota transplantation to protect or restore the commensal ecosystems of ICU patients [29,169,170].…”

Section: Discussionmentioning

confidence: 99%

Rationalizing antimicrobial therapy in the ICU: a narrative review

et al. 2019

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The massive consumption of antibiotics in the ICU is responsible for substantial ecological side effects that promote the dissemination of multidrug-resistant bacteria (MDRB) in this environment. Strikingly, up to half of ICU patients receiving empirical antibiotic therapy have no definitively confirmed infection, while de-escalation and shortened treatment duration are insufficiently considered in those with documented sepsis, highlighting the potential benefit of implementing antibiotic stewardship programs (ASP) and other quality improvement initiatives. The objective of this narrative review is to summarize the available evidence, emerging options, and unsolved controversies for the optimization of antibiotic therapy in the ICU. Published data notably support the need for better identification of patients at risk of MDRB infection, more accurate diagnostic tools enabling a rule-in/rule-out approach for bacterial sepsis, an individualized reasoning for the selection of single-drug or combination empirical regimen, the use of adequate dosing and administration schemes to ensure the attainment of pharmacokinetics/pharmacodynamics targets, concomitant source control when appropriate, and a systematic reappraisal of initial therapy in an attempt to minimize collateral damage on commensal ecosystems through de-escalation and treatment-shortening whenever conceivable. This narrative review also aims at compiling arguments for the elaboration of actionable ASP in the ICU, including improved patient outcomes and a reduction in antibiotic-related selection pressure that may help to control the dissemination of MDRB in this healthcare setting.

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The gut microbiota of critically ill patients: first steps in an unexplored world

Cited by 20 publications

References 20 publications

Microbiota-Immune Interaction in the Pathogenesis of Gut-Derived Infection

Microbiota-Immune Interaction in the Pathogenesis of Gut-Derived Infection

Gut microbiota profiles in critically ill patients, potential biomarkers and risk variables for sepsis

Rationalizing antimicrobial therapy in the ICU: a narrative review

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