Changes in the gut microbiota and risk of colonization by multidrug-resistant bacteria, infection, and death in critical care patients

Rubio, Elisa; Vergara, Andrea; Aziz, Fátima; Narvaez, S.; Cuesta, G.; Hernández, Manuel Cruz; Toapanta, David; Marco, Francesc; Fernández, Javier; Soriano, Álex; Vilà, Jordi; Casals-Pascual, Climent

doi:10.1016/j.cmi.2022.01.004

Cited by 20 publications

(26 citation statements)

References 33 publications

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“…There were 26 studies eligible for systematic review of which 7 provided moderate certainty evidence (15)(16)(17)(18)(19)(20)(21). Alpha diversity was signi cantly predictive of mortality in only one (22).…”

Section: Resultsmentioning

confidence: 99%

“…Aardema et al (21) noted low alpha diversity (Shannon index < 3) was overrepresented in patients who suffered hospital complications but this did not reach signi cance and no mortality relationship was seen. Garcia et al (17) did not nd a relationship between Shannon index and survival, although a positive association with an infrequent metric, Pielou's evenness, was seen.…”

Section: Alpha Diversitymentioning

confidence: 87%

“…Infection and sepsis were the most frequently reported subgroups. Hospital-acquired infections were seen in a mean 45.5% of patients of the four reporting studies (17,20,23,36). Wan (27), Ravi (41), Liu (29), and Du (18) et al recruited only sepsis or septic shock patients.…”

Section: Sepsismentioning

confidence: 96%

“…No relationship between alpha diversity and diagnostic category at admission was found in 5 of 6 evaluating studies (26, 32). One study reported an association between alpha diversity and the presence of cirrhosis and infection (17). No associations were observed with arti cial feeding patterns or bowel habit (41).…”

Section: Alpha Diversitymentioning

confidence: 99%

“…Although six studies had appropriate data, two studies (17,41) required exclusion due to two or more categories without mortality events. Meta-analysis of four studies (n = 402 including 85 paediatric) found no signi cant relationship between high versus low alpha diversity and odds ratio of day 28 mortality (OR 0.59, CI 0.12-4.98).…”

Section: Meta-analysis Of Alpha Diversity and Its Association With Mo...mentioning

confidence: 99%

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Lower gut dysbiosis and mortality in acute critical illness: a systematic review and meta-analysis

Evans

Ali

Anderton

et al. 2022

Preprint

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Background The human gastrointestinal tract harbours a complex multi-kingdom community known as the microb\iome. Dysbiosis refers to its disruption and is reportedly extreme in acute critical illness, yet its clinical implications are unresolved. The review systematically evaluates the relationship between gut dysbiosis and clinical outcomes of patients early in critical illness. Methods Following PRISMA guidelines, a prospectively registered search was undertaken of MEDLINE and Cochrane databases for observational studies undertaking metagenomic sequencing of the lower gastrointestinal tract of critically ill adults and children within 72hours of admission. Eligible studies reported an alpha diversity metric and one or more of the primary outcome, all cause mortality, or secondary clinical outcomes. After aggregate data was requested, meta-analysis was performed for 4 studies with mortality stratified to high or low Shannon index. Results The search identified 26 studies for systematic review and 4 had suitable data for meta-analysis. No effect of alpha diversity was seen on mortality after binary transformation of Shannon index (odds ratio 0.52, CI 0.12–4.98, I2 = 0.64) however certainty of evidence is low. Pathogen dominance and commensal depletion were each more frequently associated with mortality, adverse clinical and ecological sequalae, particularly overabundance of Enterococcus. Conclusions There is a paucity of large, rigorous observational studies in this population. Globally, alpha diversity was dynamically reduced in early ICU admission and was not associated with in-hospital mortality. The abundance of taxa such as Enterococcus spp. appear to offer greater predictive capacity for important clinical and ecological outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Alpha Diversitymentioning

confidence: 87%

Section: Sepsismentioning

confidence: 96%

Section: Alpha Diversitymentioning

confidence: 99%

Section: Meta-analysis Of Alpha Diversity and Its Association With Mo...mentioning

confidence: 99%

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Lower gut dysbiosis and mortality in acute critical illness: a systematic review and meta-analysis

Evans

Ali

Anderton

et al. 2022

Preprint

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Critical illness and the gut microbiome

Kain,

Dionne,

Marshall

2024

Intensive Care Med

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Colonization of multidrug-resistant Gram-negative bacteria increases risk of surgical site infection after hemorrhoidectomy: a cross-sectional study of two centers in southern China

Li,

Gao,

Wang

et al. 2023

Int J Colorectal Dis

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Purpose The present study aims to determine the rectoanal colonization rate and risk factors for the colonization of present multidrug-resistant bacteria (MDRBs). In addition, the relationship between MDRB colonization and surgical site infection (SSI) following hemorrhoidectomy was explored. Methods A cross-sectional study was conducted in the Department of Colorectal Surgery of two hospitals. Patients with hemorrhoid disease, who underwent hemorrhoidectomy, were included. The pre-surgical screening of multidrug-resistant Gram-negative bacteria (MDR-GNB) colonization was performed using rectal swabs on the day of admission. Then, the MDRB colonization rate was determined through the rectal swab. Logistic regression models were established to determine the risk factors for MDRB colonization and SSI after hemorrhoidectomy. A p-value of < 0.05 was considered statistically significant. Results A total of 432 patients met the inclusion criteria, and the MDRB colonization prevalence was 21.06% (91/432). The independent risk factors for MDRB colonization were as follows: patients who received ≥ 2 categories of antibiotic treatment within 3 months (odds ratio (OR): 3.714, 95% confidence interval (CI): 1.436–9.605, p = 0.007), patients with inflammatory bowel disease (IBD; OR: 6.746, 95% CI: 2.361–19.608, p < 0.001), and patients with high serum uric acid (OR: 1.006, 95% CI: 1.001–1.010, p = 0.017). Furthermore, 41.57% (37/89) of MDRB carriers and 1.81% (6/332) of non-carriers developed SSIs, with a total incidence of 10.21% (43/421). Based on the multivariable model, the rectoanal colonization of MDRBs (OR: 32.087, 95% CI: 12.052–85.424, p < 0.001) and hemoglobin < 100 g/L (OR: 4.130, 95% CI: 1.556–10.960, p = 0.004) were independently associated with SSI after hemorrhoidectomy. Conclusion The rectoanal colonization rate of MDRBs in hemorrhoid patients is high, and this was identified as an independent risk factor for SSI after hemorrhoidectomy.

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Changes in the gut microbiota and risk of colonization by multidrug-resistant bacteria, infection, and death in critical care patients

Cited by 20 publications

References 33 publications

Lower gut dysbiosis and mortality in acute critical illness: a systematic review and meta-analysis

Lower gut dysbiosis and mortality in acute critical illness: a systematic review and meta-analysis

Critical illness and the gut microbiome

Colonization of multidrug-resistant Gram-negative bacteria increases risk of surgical site infection after hemorrhoidectomy: a cross-sectional study of two centers in southern China

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