Acute Crit Care.  2023 Feb;38(1):76-85. 10.4266/acc.2022.01116.

Study of the gut microbiome as a novel target for prevention of hospital-associated infections in intensive care unit patients

Affiliations
  • 1Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Alexandria, Alexandria Governorate, Egypt
  • 2Department of Critical Care Medicine, Faculty of Medicine, University of Alexandria, Alexandria Governorate, Egypt

Abstract

Background
Hospital-acquired infections (HAIs) are increasing due to the spread of multi-drug-resistant organisms. Gut dysbiosis in intensive care unit (ICU) patients at admission showed an altered abundance of some bacterial genera associated with the occurrence of HAIs and mortality. In the present study, we investigated the pattern of the gut microbiome in ICU patients at admission to correlate it with the development of HAIs during ICU stay.
Methods
Twenty patients admitted to the ICU were included in and a cross-matching control group of 30 healthy subjects of similar age and sex. Stool specimens were collected. Quantitative SYBR green real-time polymerase chain reaction was done for the identification and quantitation of selected bacteria.
Results
Out of those twenty patients, 35% developed ventilator associated pneumonia during their ICU stay. Gut microbiome analysis showed a significant decrease in Firmicutes and Firmicutes to Bacteroidetes ratio in ICU patients in comparison to the control and in patients who developed HAIs in comparison to the control group and patients who did not develop HAIs. There was a statistically significant increase in Bacteroides in comparison to the control group. There was a statistically significant decrease in Bifidobacterium and Faecalibacterium prausnitzii and an increase in Lactobacilli in comparison to the control group with a negative correlation between Acute Physiology and Chronic Health Evaluation (APACHE) score and Firmicutes to Bacteroidetes and Prevotella to Bacteroides ratios.
Conclusions
Gut dysbiosis of patients at the time of admission highlights the importance of identification of the microbiome of patients admitted at the ICU as a target for preventing of HAIs.

Keyword

16S ribosomal RNA; dysbiosis; gut microbiome; hospital-acquired infections; intensive care unit; real-time polymerase chain reaction

Figure

  • Figure 1. Comparison between the studied groups according to gut microbiome. ICU: intensive care unit; N-HAI: negative for hospital associated infections; P-HAI: positive for hospital-associated infections.


Reference

1. Pettigrew MM, Johnson JK, Harris AD. The human microbiota: novel targets for hospital-acquired infections and antibiotic resistance. Ann Epidemiol. 2016; 26:342–7.
2. Morrow LE, Kollef MH, Casale TB. Probiotic prophylaxis of ventilator-associated pneumonia: a blinded, randomized, controlled trial. Am J Respir Crit Care Med. 2010; 182:1058–64.
3. Petrof EO, Dhaliwal R, Manzanares W, Johnstone J, Cook D, Heyland DK. Probiotics in the critically ill: a systematic review of the randomized trial evidence. Crit Care Med. 2012; 40:3290–302.
4. Buffie CG, Pamer EG. Microbiota-mediated colonization resistance against intestinal pathogens. Nat Rev Immunol. 2013; 13:790–801.
5. Rowland I, Gibson G, Heinken A, Scott K, Swann J, Thiele I, et al. Gut microbiota functions: metabolism of nutrients and other food components. Eur J Nutr. 2018; 57:1–24.
6. Iacob S, Iacob DG, Luminos LM. Intestinal microbiota as a host defense mechanism to infectious threats. Front Microbiol. 2019; 9:3328.
7. Chen Y, Zhang F, Ye X, Hu JJ, Yang X, Yao L, et al. Association between gut dysbiosis and sepsis-induced myocardial dysfunction in patients with sepsis or septic shock. Front Cell Infect Microbiol. 2022; 12:857035.
8. Szychowiak P, Villageois-Tran K, Patrier J, Timsit JF, Ruppé É. The role of the microbiota in the management of intensive care patients. Ann Intensive Care. 2022; 12:3.
9. Liu W, Cheng M, Li J, Zhang P, Fan H, Hu Q, et al. Classification of the gut microbiota of patients in intensive care units during development of sepsis and septic shock. Genomics Proteomics Bioinformatics. 2020; 18:696–707.
10. Araos R, Tai AK, Snyder GM, Blaser MJ, D’Agata EM. Predominance of Lactobacillus spp. among patients who do not acquire multidrug-resistant organisms. Clin Infect Dis. 2016; 63:937–43.
11. de Smet AM, Kluytmans JA, Cooper BS, Mascini EM, Benus RF, van der Werf TS, et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med. 2009; 360:20–31.
12. Singhi SC, Kumar S. Probiotics in critically ill children. F1000Res. 2016; 5:407.
13. Wagner DP, Draper EA. Acute physiology and chronic health evaluation (APACHE II) and Medicare reimbursement. Health Care Financ Rev. 1984; (Suppl):91–105.
14. El-Zawawy HT, Ahmed SM, El-Attar EA, Ahmed AA, Roshdy YS, Header DA. Study of gut microbiome in Egyptian patients with autoimmune thyroid diseases. Int J Clin Pract. 2021; 75:e14038.
15. Tomova A, Husarova V, Lakatosova S, Bakos J, Vlkova B, Babinska K, et al. Gastrointestinal microbiota in children with autism in Slovakia. Physiol Behav. 2015; 138:179–87.
16. Kirkpatrick LA, Feeney BC. A simple guide to IBM SPSS statistics for version 20.0. Cengage Learning;2013.
17. Shannon CE. A mathematical theory of communication. Bell Syst Tech J. 1948; 27:379–423.
18. Bray JR, Curtis JT. An ordination of the upland forest communities of southern Wisconsin. Ecol Monogr. 1957; 27:326–49.
19. Festi D, Schiumerini R, Birtolo C, Marzi L, Montrone L, Scaioli E, et al. Gut microbiota and its pathophysiology in disease paradigms. Dig Dis. 2011; 29:518–24.
20. Alverdy JC, Krezalek MA. Collapse of the microbiome, emergence of the pathobiome, and the immunopathology of sepsis. Crit Care Med. 2017; 45:337–47.
21. Song X, Chen Y, Li X. Differences in incidence and outcome of ventilator-associated pneumonia in surgical and medical ICUs in a tertiary hospital in China. Clin Respir J. 2014; 8:262–8.
22. Mariat D, Firmesse O, Levenez F, Guimarăes V, Sokol H, Doré J, et al. The Firmicutes/Bacteroidetes ratio of the human microbiota changes with age. BMC Microbiol. 2009; 9:123.
23. Collins SM, Surette M, Bercik P. The interplay between the intestinal microbiota and the brain. Nat Rev Microbiol. 2012; 10:735–42.
24. de Vos WM, de Vos EA. Role of the intestinal microbiome in health and disease: from correlation to causation. Nutr Rev. 2012; 70 Suppl 1:S45–56.
25. Ojima M, Motooka D, Shimizu K, Gotoh K, Shintani A, Yoshiya K, et al. Metagenomic analysis reveals dynamic changes of whole gut microbiota in the acute phase of intensive care unit patients. Dig Dis Sci. 2016; 61:1628–34.
26. Iapichino G, Lankelma JM, Joost Wiersinga W. Gut microbiota disruption in critically ill patients : discussion on “Critically ill patients demonstrate large interpersonal variation of intestinal microbiota dysregulation: a pilot study”. Intensive Care Med. 2017; 43:718–9.
27. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008; 36:309–32.
28. Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med. 2020; 46:888–906.
29. Elkolaly RM, Bahr HM, El-Shafey BI, Basuoni AS, Elber EH. Incidence of ventilator-associated pneumonia: Egyptian study. Egypt J Bronchol. 2019; 13:258–66.
30. Ojima M, Shimizu K, Motooka D, Ishihara T, Nakamura S, Shintani A, et al. Gut dysbiosis associated with antibiotics and disease severity and its relation to mortality in critically ill patients. Dig Dis Sci. 2022; 67:2420–32.
31. Ahmed NH, Hussain T, Biswal I. Antimicrobial resistance of bacterial isolates from respiratory secretions of ventilated patients in a multi-specialty hospital. Avicenna J Med. 2015; 5:74–8.
32. Plantinga TS, van Maren WW, van Bergenhenegouwen J, Hameetman M, Nierkens S, Jacobs C, et al. Differential Toll-like receptor recognition and induction of cytokine profile by Bifidobacterium breve and Lactobacillus strains of probiotics. Clin Vaccine Immunol. 2011; 18:621–8.
33. Sivan A, Corrales L, Hubert N, Williams JB, Aquino-Michaels K, Earley ZM, et al. Commensal Bifidobacterium promotes antitumor immunity and facilitates anti-PD-L1 efficacy. Science. 2015; 350:1084–9.
34. Xu R, Tan C, Zhu J, Zeng X, Gao X, Wu Q, et al. Dysbiosis of the intestinal microbiota in neurocritically ill patients and the risk for death. Crit Care. 2019; 23:195.
35. Wolff NS, Hugenholtz F, Wiersinga WJ. The emerging role of the microbiota in the ICU. Crit Care. 2018; 22:78.
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