Patterns of Gram-stained fecal flora as a quick diagnostic marker in patients with severe SIRS.
BACKGROUND
The gut is an important target organ of injury during critically ill conditions. Although Gram staining is a common and quick method for identifying bacteria, its clinical application has not been fully evaluated in critically ill conditions.


OBJECTIVE
This study's aims were to identify patterns of Gram-stained fecal flora and compare them to cultured bacterial counts and to investigate the association between the patterns and septic complications in patients with severe systemic inflammatory response syndrome (SIRS).


METHODS
Fifty-two patients with SIRS were included whose Gram-stained fecal flora was classified into three patterns. In a diverse pattern, large numbers of multiple kinds of bacteria completely covered the field. In a single pattern, one specific kind of bacteria or fungi predominantly covered the field. In a depleted pattern, most bacteria were diminished in the field.


RESULTS
In the analysis of fecal flora, the numbers of total obligate anaerobes in the depleted pattern was significantly lower than those in the diverse pattern and single pattern (p < 0.05). The concentrations of total organic acids, acetic acid, and propionic acid in the depleted pattern were significantly lower than those in diverse pattern and single pattern (p < 0.05). Mortality due to multiple organ dysfunction syndrome for the single pattern (52%) and the depleted pattern (64%) was significantly higher than that for the diverse pattern (6%) (p < 0.05).


CONCLUSIONS
Gram-stained fecal flora can be classified into three patterns and are associated with both cultured bacterial counts and clinical information. Gram-stained fecal bacteria can be used as a quick bedside diagnostic marker for severe SIRS patients.
Department of Clinical Quality Management, Osaka University Hospital, Osaka, Japan. kshimizu@hp-cqm.med.osaka-u.ac.jp
Kentaro
K
Shimizu
Hiroshi
H
Ogura
Kazunori
K
Tomono
Osamu
O
Tasaki
Takashi
T
Asahara
Koji
K
Nomoto
Masami
M
Morotomi
Asako
A
Matsushima
Yasutaka
Y
Nakahori
Shuhei
S
Yamano
Akinori
A
Osuka
Yasuyuki
Y
Kuwagata
Hisashi
H
Sugimoto
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000145:classification* / Q000302:isolation & purification*; D015415:Biomarkers; D005243:Feces / Q000382:microbiology*; D005260:Female; D005840:Gentian Violet; D006801:Humans; D007422:Intestines / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D010619:Phenazines; D013194:Staining and Labeling; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis* / Q000382:microbiology
D015415:Biomarkers; C035863:Gram's stain; D010619:Phenazines; D005840:Gentian Violet