Article Data

  • Views 2138
  • Dowloads 208

Original Research

Open Access

Effects of diets containing synbiotics on the gut microbiota of critically ill septic patients: a pilot randomized controlled trial

  • Kontee Wongseree1
  • Kamonnut Singkhamanan2
  • Supattra Uppanisakorn3
  • Veerapong Vattanavanit4,*,

1Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 90110 Hat Yai, Songkhla, Thailand

2Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, 90110 Hat Yai, Songkhla, Thailand

3Clinical Research Center, Faculty of Medicine, Prince of Songkla University, 90110 Hat Yai, Songkhla, Thailand

4Critical Care Medicine Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, 90110 Hat Yai, Songkhla, Thailand

DOI: 10.22514/sv.2023.080 Vol.19,Issue 5,September 2023 pp.213-224

Submitted: 08 November 2022 Accepted: 13 December 2022

Published: 08 September 2023

*Corresponding Author(s): Veerapong Vattanavanit E-mail: vveerapong@gmail.com

Abstract

The effects of synbiotics on gut microbiota have not been thoroughly clarified in critically ill patients with sepsis. In this present study, we aimed to evaluate the effects of synbiotics in a commercial diet on the gut microbiota of mechanically ventilated septic patients. This double-blind, randomized controlled clinical trial was conducted on septic patients under mechanical ventilation in a university-affiliated hospital in southern Thailand from February 2019 to March 2021. The patients were randomly divided into 2 groups stratified by sepsis stages and given commercial enteral feeding with synbiotics or standard commercial feeding for 7 days. The primary outcome was fecal microbial diversity measured as alpha and beta diversity. The secondary outcomes included ventilator-associated pneumonia, nosocomial diarrhea, ventilator days, length of hospital stay, and mortality. Twenty-four patients, 12 on a synbiotic diet and 12 on a non-synbiotic diet, completed this study. On day 3 of feeding, no significant difference was observed in their alpha fecal microbial diversity. However, significantly greater beta diversity was observed in the non-synbiotics group compared with the synbiotic group (Bray Curtis distance, p = 0.001; Jaccard’s distance, p = 0.001; unweighted UniFrac, p = 0.001; weighted UniFrac, p = 0.029). The secondary outcomes were not significantly different between the two groups. In critically ill septic patients, feeding with a commercial diet containing synbiotics did not significantly improve fecal microbial diversity. Due to the small sample size, further study is required.


Keywords

Gut microbiota; Microbial diversity; Sepsis; Synbiotics; Intensive care unit


Cite and Share

Kontee Wongseree,Kamonnut Singkhamanan,Supattra Uppanisakorn,Veerapong Vattanavanit. Effects of diets containing synbiotics on the gut microbiota of critically ill septic patients: a pilot randomized controlled trial. Signa Vitae. 2023. 19(5);213-224.

References

[1] Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016; 315: 801–810.

[2] Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. The Lancet. 2020; 395: 200–211.

[3] McDonald D, Ackermann G, Khailova L, Baird C, Heyland D, Kozar R, et al. Extreme dysbiosis of the microbiome in critical illness. mSphere. 2016; 1: e00199-16.

[4] Lankelma JM, van Vught LA, Belzer C, Schultz MJ, van der Poll T, de Vos WM, et al. Critically ill patients demonstrate large interpersonal variation in intestinal microbiota dysregulation: a pilot study. Intensive Care Medicine. 2017; 43: 59–68.

[5] Yeh A, Rogers MB, Firek B, Neal MD, Zuckerbraun BS, Morowitz MJ. Dysbiosis across multiple body sites in critically ill adult surgical patients. Shock. 2016; 46: 649–654.

[6] Kitsios GD, Morowitz MJ, Dickson RP, Huffnagle GB, McVerry BJ, Morris A. Dysbiosis in the intensive care unit: microbiome science coming to the bedside. Journal of Critical Care. 2017; 38: 84–91.

[7] Manzanares W, Lemieux M, Langlois PL, Wischmeyer PE. Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis. Critical Care. 2016; 19: 262.

[8] Garcia ER, Vergara A, Aziz F, Narváez S, Cuesta G, Hernández M, et al. Changes in the gut microbiota and risk of colonization by multidrug-resistant bacteria, infection, and death in critical care patients. Clinical Microbiology and Infection. 2022; 28: 975–982.

[9] Prevel R, Enaud R, Orieux A, Camino A, Berger P, Boyer A, et al. Gut bacteriobiota and mycobiota are both associated with Day-28 mortality among critically ill patients. Critical Care. 2022; 26: 105.

[10] Weng H, Li JG, Mao Z, Feng Y, Wang CY, Ren XQ, et al. Probiotics for preventing ventilator-associated pneumonia in mechanically ventilated patients: a meta-analysis with trial sequential analysis. Frontiers in Pharmacology. 2017; 8: 717.

[11] Ruppé É, Lisboa T, Barbier F. The gut microbiota of critically ill patients: first steps in an unexplored world. Intensive Care Medicine. 2018; 44: 1561–1564.

[12] Lau CS, Chamberlain RS. Probiotics are effective at preventing Clostridium difficile-associated diarrhea: a systematic review and meta-analysis. International Journal of General Medicine. 2016; 9: 27–37.

[13] Shimizu K, Ogura H, Goto M, Asahara T, Nomoto K, Morotomi M, et al. Synbiotics decrease the incidence of septic complications in patients with severe sirs: a preliminary report. Digestive Diseases and Sciences. 2009; 54: 1071–1078.

[14] Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM consensus conference committee. American college of chest physicians/society of critical care medicine. Chest. 1992; 101: 1644–1655.

[15] Nestle Health Science. 2022. Available at: https://www. nestlehealthscience-th.com/brands/Boost/boost-optimum?gclid=CjwKCAiAv9riBRANEiwA9Dqv1Tdj5K4YOGsAzisN9RyVZrE-IGs2dAsh5oEH24Ok3kD4iI9Kg2x5ehoCzBwQAvD_BwE.&utm_ campaign=2018-adwords-th_th-aging-boost&utm_source= google&utm_medium=cpc&utm_content=gg_brand (Accessed: 18 June 2019).

[16] Sarangi AN, Goel A, Aggarwal R. Methods for studying gut microbiota: a primer for physicians. Journal of Clinical and Experimental Hepatology. 2019; 9: 62–73.

[17] American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. American Journal of Respiratory and Critical Care Medicine. 2005; 171: 388–416.

[18] Polage CR, Solnick JV, Cohen SH. Nosocomial diarrhea: evaluation and treatment of causes other than clostridium difficile. Clinical Infectious Diseases. 2012; 55: 982–989.

[19] Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharmaceutical Statistics. 2005; 4: 287–291.

[20] Morrow LE, Kollef MH, Casale TB. Probiotic prophylaxis of ventilator-associated pneumonia: a blinded, randomized, controlled trial. American Journal of Respiratory and Critical Care Medicine. 2010; 182: 1058–1064.

[21] Bunout D, Barrera G, Hirsch S, Gattas V, de la Maza MP, Haschke F, et al. Effects of a nutritional supplement on the immune response and cytokine production in free-living Chilean elderly. Journal of Parenteral and Enteral Nutrition. 2004; 28: 348-354.

[22] Shimizu K, Yamada T, Ogura H, Mohri T, Kiguchi T, Fujimi S, et al. Synbiotics modulate gut microbiota and reduce enteritis and ventilator-associated pneumonia in patients with sepsis: a randomized controlled trial. Critical Care. 2018; 22: 239.

[23] Simakachorn N, Bibiloni R, Yimyaem P, Tongpenyai Y, Varavithaya W, Grathwohl D, et al. Tolerance, safety, and effect on the faecal microbiota of an enteral formula supplemented with pre- and probiotics in critically ill children. Journal of Pediatric Gastroenterology & Nutrition. 2011; 53: 174–181.

[24] Angurana SK, Bansal A, Singhi S, Aggarwal R, Jayashree M, Salaria M, et al. Evaluation of effect of probiotics on cytokine levels in critically ill children with severe sepsis: a double-blind, placebo-controlled trial. Critical Care Medicine. 2018; 46: 1656–1664.

[25] McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Journal of Parenteral and Enteral Nutrition. 2016; 40: 159–211.

[26] von Schwartzenberg RJ, Bisanz JE, Lyalina S, Spanogiannopoulos P, Ang QY, Cai J, et al. Caloric restriction disrupts the microbiota and colonization resistance. Nature. 2021; 595: 272–277.

[27] Taur Y, Xavier JB, Lipuma L, Ubeda C, Goldberg J, Gobourne A, et al. Intestinal domination and the risk of bacteremia in patients undergoing allogeneic hematopoietic stem cell transplantation. Clinical Infectious Diseases. 2012; 55: 905–914.

[28] Shen W, Sun J, Yao F, Lin K, Yuan Y, Chen Y, et al. Microbiome in intestinal lavage fluid may be a better indicator in evaluating the risk of developing colorectal cancer compared with fecal samples. Translational Oncology. 2020; 13: 100772.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.3 (2023) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top