Patterns of Gram-Stained Fecal Flora as a Quick Diagnostic Marker in Patients with Severe SIRS

Abstract

BackgroundThe gut is an important target organ of injury during critically ill conditions. Although Gram staining is a common and quick method for identifying bacteria, its clinical application has not been fully evaluated in critically ill conditions.AimsThis study’s aims were to identify patterns of Gram-stained fecal flora and compare them to cultured bacterial counts and to investigate the association between the patterns and septic complications in patients with severe systemic inflammatory response syndrome (SIRS).MethodsFifty-two patients with SIRS were included whose Gram-stained fecal flora was classified into three patterns. In a diverse pattern, large numbers of multiple kinds of bacteria completely covered the field. In a single pattern, one specific kind of bacteria or fungi predominantly covered the field. In a depleted pattern, most bacteria were diminished in the field.ResultsIn the analysis of fecal flora, the numbers of total obligate anaerobes in the depleted pattern was significantly lower than those in the diverse pattern and single pattern (p < 0.05). The concentrations of total organic acids, acetic acid, and propionic acid in the depleted pattern were significantly lower than those in diverse pattern and single pattern (p < 0.05). Mortality due to multiple organ dysfunction syndrome for the single pattern (52%) and the depleted pattern (64%) was significantly higher than that for the diverse pattern (6%) (p < 0.05).ConclusionsGram-stained fecal flora can be classified into three patterns and are associated with both cultured bacterial counts and clinical information. Gram-stained fecal bacteria can be used as a quick bedside diagnostic marker for severe SIRS patients.

Antibiotic-induced gut microbiota disruption during human endotoxemia: a randomised controlled study

“…Still, demonstrating such a subtle effect in a heterogeneous patient population may be quite hard. Small descriptive studies of faecal microbiota in critically ill patients have associated higher bacterial diversity with better outcome37 38 and a large retrospective cohort study-associated dysbiosis in the gut with higher incidence of subsequent severe sepsis 39. The latter identified 43 095 hospitalisations among 10 996 patients and divided them into three diagnosis groups based on likelihood of intestinal microbiota disturbance (non-infection: not likely, infection: likely, C. difficile infection: very likely).…”

Gut microbiome, surgical complications and probiotics

“…The equilibrium between obligate anaerobes and total facultative anaerobes seems to play a critical role in causing septic complications: during the unfavorable evolution of SIRS, alterations in gut bacteria usually progress from a diverse pattern to a single pattern and then on to a depleted pattern, the three types representing a continuum of abnormality, depending on the severity of the patient’s condition. Bacteremia was evident in 35% of those with a diverse pattern versus 71% with the single pattern, resulting in a mortality rate of 6% in the former, 52% in the letter, and 64% in those with a depleted pattern (P<0.05) [48]. …”

Microbiome in the Critically Ill

“…The feces of patients with severe systemic infl ammatory response syndrome (SIRS) was collected and studied. Classifi cation as diverse, depleted, or single was determined via visual analysis of gram stain bacterial isolates from stool [ 47 ]. Further analysis of the bacteria was pursued via culture [ 46 , 47 ].…”