title: Gastrointestinal dysmotility is associated with altered gut flora and septic mortality in patients with severe systemic inflammatory response syndrome: a preliminary study.
abstract: BACKGROUND
  The gut is an important target organ for injury after severe insult, and resolution of feeding intolerance is crucial for critically ill patients. We investigated gut flora and motility to evaluate the impact of gastrointestinal dysmotility on septic complications in patients with severe systemic inflammatory response syndrome (SIRS).
  
  
  METHODS
  Sixty-three ICU patients with severe SIRS were divided into two groups depending on their intestinal condition. Patients with feeding intolerance comprised patients who had feeding intolerance, defined as ≥ 300 mL reflux from nasal gastric feeding tube in 24 h, and patients without feeding intolerance comprised patients with no feeding intolerance. We compared fecal microflora, incidences of bacteremia, and mortality between these groups.
  
  
  RESULTS
  Analysis of feces showed that patients with feeding intolerance had significantly lower numbers of total obligate anaerobes including Bacteroidaceae and Bifidobacterium, higher numbers of Staphylococcus, lower concentrations of acetic acid and propionic acid, and higher concentrations of succinic acid and lactic acid than those in patients without feeding intolerance (P ≤ 0.05). Patients with feeding intolerance had higher incidences of bacteremia (86%vs 18%) and mortality (64%vs 20%) than did patients without feeding intolerance (P ≤ 0.05).
  
  
  CONCLUSIONS
  Gut flora and organic acids were significantly altered in patients with severe SIRS complicated by gastrointestinal dysmotility, which was associated with higher septic mortality in SIRS patients.
authors.affiliation: Department of Clinical Quality Management, Osaka University Hospital, Suita-City, Osaka, Japan. kshimizu@hp-cqm.med.osaka-u.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Shimizu
authors.forename: H
authors.initials: H
authors.lastname: Ogura
authors.forename: T
authors.initials: T
authors.lastname: Asahara
authors.forename: K
authors.initials: K
authors.lastname: Nomoto
authors.forename: M
authors.initials: M
authors.lastname: Morotomi
authors.forename: Y
authors.initials: Y
authors.lastname: Nakahori
authors.forename: A
authors.initials: A
authors.lastname: Osuka
authors.forename: S
authors.initials: S
authors.lastname: Yamano
authors.forename: M
authors.initials: M
authors.lastname: Goto
authors.forename: A
authors.initials: A
authors.lastname: Matsushima
authors.forename: O
authors.initials: O
authors.lastname: Tasaki
authors.forename: Y
authors.initials: Y
authors.lastname: Kuwagata
authors.forename: H
authors.initials: H
authors.lastname: Sugimoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001438:Bacteroidaceae / Q000302:isolation & purification; D001644:Bifidobacterium / Q000302:isolation & purification; D004750:Enteral Nutrition; D001068:Feeding and Eating Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000503:physiopathology*; D005769:Gastrointestinal Motility / Q000502:physiology*; D041981:Gastrointestinal Tract / Q000382:microbiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013210:Staphylococcus / Q000302:isolation & purification; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications / Q000401:mortality*