Altered gut flora are associated with septic complications and death in critically ill patients with systemic inflammatory response syndrome

Abstract

Background: Gut under severe insult is considered to have an important role in promoting infection and multiple organ dysfunction syndrome from the viewpoint of altered intestinal epithelium, immune system and commensal bacteria. There are few reports, however, about the relationship between gut flora and septic complications.

Methods: We analyzed gut flora in patients with systemic inflammatory response syndrome (SIRS) and evaluated key bacteria and their cutoff values for infectious complications and mortality by using classification and regression trees (CART). Eighty-one SIRS patients with a serum C-reactive protein level higher than 10 mg/dL treated in the intensive care unit (ICU) for more than 2 days were included for the study. We quantitatively evaluated nine types of bacteria in fecal samples by plate or tube technique. Two hundred seventy-one samples were analyzed using CART and logistic regression.

Results: The dominant factors for complication of enteritis were the minimum number of total obligate anaerobes and the maximum number of Staphylococcus and Enterococcus. The dominant factors for complication of bacteremia were the minimum numbers of total obligate anaerobes and total facultative anaerobes. The dominant factors for mortality were the numbers of total obligate anaerobes and total facultative anaerobes and age.

Conclusions: A decrease in total obligate anaerobes and an increase in pathogenic bacteria in the gut are associated with septic complications and mortality in patients with SIRS. The altered gut flora may be a potential prognostic marker in SIRS patients.

Fig. 1

Incidences of enteritis partitioned by total obligate anaerobes (min), Staphylococcus (max), and Enterococcus (max) using CART. Total obligate anaerobes (min), the minimum number of total obligate anaerobes; Staphylococcus (max), the maximum number of Staphylococcus; Enterococcus (max), the maximum number of Enterococcus; CART, classification and regression trees

Fig. 2

Incidences of bacteremia partitioned by total obligate anaerobes (min) and total facultative anaerobes (min) using CART. Total obligate anaerobes (min), the minimum number of total obligate anaerobes; Total facultative anaerobes (max), the maximum number of total facultative anaerobes; CART, classification and regression trees

Fig. 3

Mortality partitioned by total obligate anaerobes, total facultative anaerobes, and age using CART. Total obligate anaerobes, the number of total obligate anaerobes; Total facultative anaerobes, the number of total facultative anaerobes at the last sample; CART, classification and regression trees