Clinical Multi-Omics Study on the Gut Microbiota in Critically Ill Patients After Cardiovascular Surgery Combined With Cardiopulmonary Bypass With or Without Sepsis (MUL-GM-CSCPB Study): A Prospective Study Protocol

Abstract

Introduction: Fever of unknown origin (FUO) and hemodynamic instability are complications that develop after cardiac surgery combined with cardiopulmonary bypass (CPB) for heart disease. Patients who develop fever with hemodynamic instability after cardiac surgery may have systemic inflammatory response syndrome or sepsis. Cardiopulmonary bypass (CPB) is a technique that temporarily takes over the function of the heart and lungs during cardiac surgery. Recent reports suggest that early bloodstream infections of patients undergoing CPB are due to gram-negative bacteria that are present in the intestinal flora. The theory of intestinal flora translocation has growing evidence. Intestinal ischemia-reperfusion that occurs during cardiac surgery with CPB will induce a systemic inflammatory reaction and may cause intestinal flora translocation. Does this systemic reaction cause sepsis? We therefore propose this protocol to determine whether the changes in the intestinal flora in patients after cardiac surgery with CPB are related to sepsis. Methods and Analysis: This study is a prospective observational case-control study to analyze the variation in the intestinal microflora and metabolites in patients undergoing cardiac surgery with CPB and to observe the outcomes of patients with routine clinical interventions. The control group will include healthy people without intestinal illness. Feces and blood samples will be acquired 1 day before cardiac surgery and within 24-72 h after cardiac surgery, and will be used for genomics and metabolomics analyses. Demographic data describing age, sex, main diagnosis, and past medical history and data related to the CPB time and application of antibiotics are available. Sequential (sepsis-related) organ failure assessment, infection-related laboratory items, infection site, and pathogenic microorganisms, and nutrition, and Ding et al. Multi-Omics on Cardiovascular Surgery Combined CPB gastrointestinal function assessment are additionally recorded. Group analysis of data will be conducted according to the outcomes (sepsis vs. non-sepsis and survivors vs. non-survivors). Ethics and Dissemination: This protocol has been ethically approved by the Ethics Committee of Peking Union Medical College (ID: ZS-1612). Informed consent will be obtained before subject enrolment, and data will be stored in a secured database. The results will be submitted to international peer-reviewed journals and presented at international conferences. Trial Registration Number: NCT04032938.

Rates and Determinants of Hospital-Acquired Infection among ICU Patients Undergoing Cardiac Surgery in Developing Countries: Results from EMERGENCY’NGO’s Hospital in Sudan

“…From a microbiological point of view, a large number of infections observed were due to pathogens included in the family of Enterobacteriaceae . This can be explained by considering that intestinal ischaemia reperfusion that occurs during cardiac surgery and in end-stage cardiovascular diseases will induce a systemic inflammatory reaction and may cause intestinal flora translocation [ 20 ]. Interestingly, among Enterobacteriaceae isolated in our cohort, 40.7% were carbapenem-resistant.…”

The association between culture positivity and long-term mortality in critically ill surgical patients

“…As we have identified in the present study, the early predictors for long-term mortality should provide evidence for risk stratification and early intervention, such as the implementation of physical, psychological and nutritional support, among critically ill surgical patients during and after the ICU admission [ 28 ]. Furthermore, the culture positivity may potentially reflect the alternation of microbiota, and accumulating evidence have shown the crucial role of microbiota among critically ill patients in the past decade [ 8 , 27 ]. Freedberg et al .…”

“…Increasing evidence have shown the crucial role of chronic critical illness (CCI), characterised by persistent organ dysfunction, vulnerability for secondary infection, prolonged ICU course and high resource utilisation after discharge, among critically ill surgical patients [ 7 ]. A number of studies have demonstrated the critical illness-associated prolonged microbial alternation among critically ill surgical patients [ 8 – 10 ]. One recent study further characterised CCI with the prolonged immunological and metabolic alternation in 144 critically ill surgical patients with abdominal infection [ 11 ].…”

The microbiome’s relationship with congenital heart disease: more than a gut feeling

“…The intestinal microbiome is important in regulating health and homeostasis [15][16][17][18], and its dysregulation (termed intestinal dysbiosis) has been well studied in critical illness [19][20][21] and the cardiac surgical population [22][23][24]. With dysbiosis, an imbalance in the normal microflora of the gut occurs.…”