Pathogen colonization of the gastrointestinal microbiome at intensive care unit admission and risk for subsequent death or infection

Freedberg, Daniel E.; Zhou, Margaret; Cohen, Morton I.; Annavajhala, Medini K.; Khan, Sobia; Moscoso, Dagmara I.; Brooks, Christian; Whittier, Susan; Chong, David H.; Uhlemann, Anne‐Catrin; Abrams, Julian A.

doi:10.1007/s00134-018-5268-8

Cited by 154 publications

(150 citation statements)

References 39 publications

Supporting

Mentioning

143

Contrasting

Order By: Relevance

“…An untargeted hierarchical linear discriminant analysis (LDA) effect size algorithm (LEfSe) was used with sequencing results to identify altered taxa based on fiber intake. Additionally, Enterococcus relative abundance was prespecified as a secondary outcome of interest within the gastrointestinal microbiome because our previous study identified it as an independent predictor of death and infection in the ICU study . Standard microbiome α diversity measures (Shannon and Chao index) were assessed also based on 16S rRNA gene sequencing.…”

Section: Methodsmentioning

confidence: 99%

“…In bone marrow transplant recipients and selective ICU cohorts, increased abundance of SCFA‐producing bacteria was associated with decreased MDR organism colonization, including decreased vancomycin‐resistant Enterococcus (VRE) . In the ICU, diminished levels of SCFA producers have been associated with higher Enterococcus and risk for death . In healthy volunteers and ambulatory patients, fiber is well tolerated and increases SCFA producer levels …”

Section: Introductionmentioning

confidence: 99%

“…8,10 In the ICU, diminished levels of SCFA producers have been associated with higher Enterococcus and risk for death. 11 In healthy volunteers and ambulatory patients, fiber is well tolerated and increases SCFA producer levels. 12 For these reasons, fiber may be an appropriate prebiotic to test in the ICU.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Relationship Between Dietary Fiber Intake and Short‐Chain Fatty Acid–Producing Bacteria During Critical Illness: A Prospective Cohort Study

Moscoso

Porter

et al. 2019

J Parenter Enteral Nutr

Self Cite

View full text Add to dashboard Cite

Background Dietary fiber increases short‐chain fatty acid (SCFA)‐producing bacteria yet is often withheld in the intensive care unit (ICU). This study evaluated the safety and effect of fiber in ICU patients with gut microbiome sampling. Methods This was a retrospective study nested within a prospective cohort. Adults were included if newly admitted to the ICU and could receive oral nutrition, enteral feedings, or no nutrition. Rectal swabs were performed at admission and 72 hours later. The primary exposure was fiber intake over 72 hours, classified in tertiles and adjusted for energy intake. The primary outcome was the relative abundance (RA) of SCFA producers via 16S RNA sequencing and the tolerability of fiber. Results In 129 patients, median fiber intake was 13.4 g (interquartile range 0–35.4 g) over 72 hours. The high‐fiber group had less abdominal distension (11% high fiber vs 28% no fiber, P < .01) and no increase in diarrhea (15% high fiber vs 13% no fiber, P = .94) or other adverse events. The median RA of SCFA producers after 72 hours was 0.40%, 0.50%, and 1.8% for the no‐, low‐, and high‐fiber groups (P = .05 for trend). After correcting for energy intake, the median RA of SCFA producers was 0.41%, 0.32%, and 2.35% in the no‐, low‐, and high‐corrected‐fiber categories (P < .01). These associations remained significant after adjusting for clinical factors including antibiotics. Conclusions During the 72 hours after ICU admission, fiber was well tolerated, and higher fiber intake was associated with more SCFA‐producers.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Relationship Between Dietary Fiber Intake and Short‐Chain Fatty Acid–Producing Bacteria During Critical Illness: A Prospective Cohort Study

Moscoso

Porter

et al. 2019

J Parenter Enteral Nutr

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although it is possible that the microbiota profiles in these patients serve as surrogate markers of critical illness, emerging evidence also shows that the microbiota can conversely influence disease activity. In a prospective study of 301 patients in the medical ICU, the presence of Enterococcus in the stool at the time of admission was associated with all‐cause infection or death . Rectal carriage of certain organisms ( Enterococcus , Escherichia coli , C. difficile , Pseudomonas , and Klebsiella ) was also associated with subsequent extraintestinal culture–proven infection with the same organism.…”

Section: Introductionmentioning

confidence: 99%

Fecal Microbiota Transplantation for the Critically Ill Patient

et al. 2018

View full text Add to dashboard Cite

The gut microbiome has been implicated in a diversity of diseases, such as irritable bowel syndrome, inflammatory bowel disease, hepatic steatosis, metabolic syndrome, obesity, and anxiety. Current research also suggests the presence of a bidirectional relationship between the composition of the gut microbiome and critical illness. In the critical care setting, multiple factors (eg, use of antibiotics, aberrant nutrition, bloodstream infections, bowel ischemia, and abnormal bowel motility) strongly contribute to intestinal dysbiosis. Conversely, early studies have associated intestinal dysbiosis with worse clinical outcomes in the intensive care unit (ICU), such as infection, organ failure, and mortality. The possibility of intestinal dysbiosis influencing these clinical outcomes has prompted the question of whether microbiome manipulation strategies, such as fecal microbiota transplantation (FMT), may have a role in the management of critical illness. After a literature search of FMT used in the ICU for indications other than Clostridium difficile infections, we found 4 case reports that describe the use of FMT in 5 critically ill patients with systemic inflammatory responses and no clear source of infection. This review discusses the relationship between the gut microbiome and critical illness, early data on the use of FMT in critical care, and safety considerations of FMT in the critically ill and immunocompromised populations.

show abstract

“…The paper by Freedberg et al [16] in this issue of Intensive Care Medicine provides novel insights to appraise how the characteristics of the gut microbiota upon ICU admission may predict death or subsequent infection in critically ill patients. A total of 301 patients were prospectively included in this single-ICU study.…”

mentioning

confidence: 99%

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

2018

View full text Add to dashboard Cite

Pathogen colonization of the gastrointestinal microbiome at intensive care unit admission and risk for subsequent death or infection

Abstract: Enterococcus status at ICU admission was associated with risk for death or all-cause infection, and rectal carriage of common ICU pathogens predicted specific infections. The gastrointestinal microbiome may have a role in risk stratification and early diagnosis of ICU infections.

Cited by 154 publications

References 39 publications

Relationship Between Dietary Fiber Intake and Short‐Chain Fatty Acid–Producing Bacteria During Critical Illness: A Prospective Cohort Study

Relationship Between Dietary Fiber Intake and Short‐Chain Fatty Acid–Producing Bacteria During Critical Illness: A Prospective Cohort Study

Fecal Microbiota Transplantation for the Critically Ill Patient

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

Contact Info

Product

Resources

About