Critically ill patients demonstrate large interpersonal variation in intestinal microbiota dysregulation: a pilot study

• Published in: Intensive care medicine Vol. 43; no. 1; pp. 59 - 68
• Main Authors: Lankelma, Jacqueline M., van Vught, Lonneke A., Belzer, Clara, Schultz, Marcus J., van der Poll, Tom, de Vos, Willem M., Wiersinga, W. Joost
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2017; Springer; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Analysis; Anesthesiology; Anti-Bacterial Agents - adverse effects; Antibiotics; Biomarkers - analysis; Clinical outcomes; Critical Care Medicine; Critical Illness; Critically ill; Emergency Medicine; Feces; Feces - microbiology; Female; Firmicutes; Gastrointestinal Microbiome - drug effects; Gut microbiota; Humans; Infection; Intensive; Intensive care; Intensive care unit; Male; Medicine; Medicine & Public Health; Microbiota; Microbiota (Symbiotic organisms); Middle Aged; Mortality; Netherlands; Nosocomial infections; Original; Pain Medicine; Patients; Pediatrics; Physiological aspects; Pilot Projects; Pneumology/Respiratory System; Prospective Studies; RNA; Sepsis; Sepsis - microbiology; Software; Netherlands; Gut microbiota; Sepsis; Antibiotics; Critically ill; Intensive care unit
• ISSN: 0342-4642; 1432-1238; 1432-1238
• DOI: 10.1007/s00134-016-4613-z

Purpose The intestinal microbiota has emerged as a virtual organ with essential functions in human physiology. Antibiotic-induced disruption of the microbiota in critically ill patients may have a negative influence on key energy resources and immunity. We set out to characterize the fecal microbiota composition in critically ill patients both with and without sepsis and to explore the use of microbiota-derived markers for clinical outcome measurements in this setting. Methods In this prospective observational cohort study we analyzed the fecal microbiota of 34 patients admitted to the intensive care unit. Fifteen healthy subjects served as controls. The fecal microbiota was phylogenetically characterized by 16S rRNA gene sequencing, and associations with clinical outcome parameters were evaluated. Results A marked shift in fecal bacterial composition was seen in all septic and non-septic critically ill patients compared with controls, with extreme interindividual differences. In 13 of the 34 patients, a single bacterial genus made up >50% of the gut microbiota; in 4 patients this was even >75%. A significant decrease in bacterial diversity was observed in half of the patients. No associations were found between microbiota diversity, Firmicutes/Bacteroidetes ratio, or Gram-positive/Gram-negative ratio and outcome measurements such as complications and survival. Conclusions We observed highly heterogeneous patterns of intestinal microbiota in both septic and non-septic critically ill patients. Nevertheless, some general patterns were observed, including disappearance of bacterial genera with important functions in host metabolism. More detailed knowledge of the short- and long-term health consequences of these major shifts in intestinal bacterial communities is needed.