نوشته‌شده در

The role of the microbiota in the management of intensive care patients

The role of the microbiota in the management of intensive care patients

In the gut, the microbiota mostly comprised bacteria, but it also harbors archaea, viruses, protozoans, and fungi. The composition of the gut microbiota is unique to each individual in that the gut microbiota of two given individuals consistently show differences in their composition. Nonetheless, it is also highly dynamic and evolves throughout life under the influence of a wide diversity of genetic, environmental, medical, and dietary determinants.

The microbiota and intensive care patients

In the intensive care setting, the gut microbiota of patients is submitted to various stresses including antibiotic exposure, modification of gastrointestinal transit, artificial nutrition or sepsis which may lead to a dysbiosis during hospitalization. Indeed, the gut microbiota in critically ill patients appears to be different from that of healthy subjects, demonstrating markedly lower richness and diversity, and the near replacement of commensal genera by opportunistic pathogens. Recent evidence has shown that dysbiosis in ICU patients might have consequences on survival, stressing that dysbiosis could be considered as an authentic, organ-failure-affecting prognosis along with renal, cardiac, or respiratory failures.

Dysbiosis alteration and patients’ management

The gut microbiota mainly includes difficult-to-cultivate anaerobic bacteria, hence knowledge about its composition has significantly arisen from culture-independent methods based on next-generation sequencing (NGS) such as 16S profiling and shotgun metagenomics.

Correcting the microbiota disturbances to avoid their consequences is now possible. Fecal microbiota transplantation is recommended in recurrent C. difficile infections and microbiota-protecting treatments such as antibiotic inactivators are currently being developed. The growing interest in the microbiota and microbiota-associated therapies suggests that the control of the dysbiosis could be a key factor in the management of critically ill patients.

The gut microbiota is also the main reservoir for multidrug-resistant bacteria organisms (MDRO). Initially kept at low intestinal concentrations as a consequence of the barrier effect exerted by commensal anaerobic bacteria, they may bloom after antibiotic exposure and increase the risk their involvement in further infections.

prepared by: Nazila Kassaian

Reference

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 Jan 5;12(1):3. doi: 10.1186/s13613-021-00976-5. PMID: 34985651; PMCID: PMC8728486.

نوشته‌شده در

Obesity, Overweight and the Microbiome

Overweight and obesity, among the most common diseases in the world, contribute to other pathological conditions including cardiovascular disease, cancer, and metabolic syndrome. Overweight and obesity produce changes in the gut microbiota because of altering intestinal permeability (endo-toxemia), stimulating the endocannabinoid system, and increasing the provision of calories. All these alterations must be considered in a treatment strategy to return a patient to homeostasis. Such strategies have the potential not only of improving the health of individuals, but also of enabling enormous savings in the health care system.

Overweight and Obesity Treatment by gut microbiota alteration

Numerous reports refer to beneficial effects of probiotics in overweight or obese individuals. Indigestible oligosaccharides, inulin, lactulose and resistant starch which act as prebiotics, enhance the amount of probiotics and are effective for weight loss. Synbiotic which is the combination of probiotic and prebiotics, is recommended by the physician attending an overweight or obese patient.  The intake of postbiotic and para-probiotics also improves the condition of excess body fat.

Morbid obesity can be treated with intestinal microbiota transplantation at a lower cost and with less morbidity than bypasses. For a patient that has already undergone a bypass, probiotics, prebiotics, or synbiotics along with exercise is recommended to continue to control weight by modulating the intestinal microbiota. Of course, the indications of the FDA must be considered when performing intestinal microbiota transplantation.

Conclusion

Dysbiosis is caused by many factors such as stress, diet, medications, and metabolic disorders. Many studies have found that diet, probiotics, prebiotics, symbionts, intestinal microbiota transplantation, and fecal microbiota transplantation can help overweight and obese patients significantly reduce excess body fat.

reference

 Tiburcio ÁZ. Obesity, Overweight, and the Microbiome. EC Gastroenterology and Digestive System. 2021;8.

نوشته‌شده در

Danish national guideline for the treatment of Clostridioides difficile infection and use of fecal microbiota transplantation (FMT)

Clostridioides (formerly Clostridium) difficile (CD) infection (CDI) is a major cause of nosocomial diarrhea and accounts for 20–۳۰% of cases of antibiotic-associated diarrhea. The disease poses a persistent health threat, is associated with a high mortality and generates considerable hospital costs.

Fecal microbiota transplantation (FMT) is the transfer of minimally processed faeces from a healthy donor to a patient in order to treat disease. The method has been used in modern medical science since 1958. Its clinical effect in recurrent CDI (rCDI) has been documented in observational and randomized studies. The use of FMT in the treatment of other conditions is being explored in clinical trials. In the future, the use of microbiota-based drugs may potentially replace or supplement FMT. The basis for this clinical guideline is the use of FMT in patients with CDI. Experimental treatments and indications for FMT are briefly discussed.

Method

The formation of this guideline followed the preform for clinical guidelines, including representation in the working group by specialists, doctors in training, university hospitals, regional hospitals, and all geographic regions of Denmark. The process and the final guideline were endorsed by the Danish Society for Gastroenterology and Hepatology, the Danish Society of Infectious Diseases, the Danish Society for Clinical Microbiology, and the Danish Immunology Society for Clinical Immunology, following a hearing process in each scientific society. Each scientific society appointed at least two working group members.

Results

 In CD infection, the use of marketed and experimental antibiotics as well as microbiota-based therapies including FMT are described. An algorithm for evaluating treatment effect is suggested. The organization of FMT, donor recruitment and screening, laboratory preparation, clinical application and follow-up are described.

Conclusion

 In this Danish national guideline, updated evidence for the treatment of CD infection and the use of FMT is provided.

Key Words

FMT, CDI, Treatment, Guideline

Reference

Baunwall SM, Dahlerup JF, Engberg JH, Erikstrup C, Helms M, Juel MA, Kjeldsen J, Nielsen HL, Nilsson AC, Rode AA, Vinter-Jensen L. Danish national guideline for the treatment of Clostridioides difficile infection and use of faecal microbiota transplantation (FMT). Scandinavian Journal of Gastroenterology. 2021 Sep 2; 56(9):1056-77.