title: Intestinal microbial diversity and perioperative complications.
abstract: OBJECTIVE
  Enteral nutrient deprivation via parenteral nutrition (PN) in a mouse model leads to a local mucosal inflammatory response. This proinflammatory response leads to a loss of epithelial barrier function and atrophy of the intestine. Although the underlying mechanisms are unknown, a potential contributing factor is the impact PN has on the intestinal microbiome. We recently identified a shift in the intestinal microbial community in mice given PN; however, it is unknown whether such changes occur in humans. We hypothesized that similar microbial changes occur in humans during periods of enteral nutrient deprivation.
  
  
  METHODS
  A series of small bowel specimens were obtained from pediatric and adult patients undergoing small intestinal resection. Mucosally associated bacteria were harvested and analyzed using 454 pyrosequencing techniques. Statistical analysis of microbial diversity and differences in microbial characteristics were assessed between enterally fed and enterally deprived portions of the intestine. Occurrence of postoperative infectious and anastomotic complications was also examined.
  
  
  RESULTS
  Pyrosequencing demonstrated a wide variability in microbial diversity within all groups. Principal coordinate analysis demonstrated only a partial stratification of microbial communities between fed and enterally deprived groups. Interestingly, a tight correlation was identified in patients who had a low level of enteric microbial diversity and those who developed postoperative enteric-derived infections or intestinal anastomotic disruption.
  
  
  CONCLUSIONS
  Loss of enteral nutrients and systemic antibiotic therapy in humans is associated with a significant loss of microbial biodiversity within the small bowel mucosa. These changes were associated with a number of enteric-derived intestinal infections and intestinal anastomotic disruptions.
authors: Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors: Matthew W
authors: MW
authors: Ralls
authors: Eiichi
authors: E
authors: Miyasaka
authors: Daniel H
authors: DH
authors: Teitelbaum
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007410:Intestinal Diseases / Q000209:etiology / Q000382:microbiology; D007422:Intestines / Q000382:microbiology*; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects* / Q000379:methods; D019990:Perioperative Care / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000382:microbiology; D016896:Treatment Outcome; D055815:Young Adult
keywords: intestine; microbiota; microflora; parenteral nutrition
references: Clin Nutr. 2009 Aug;28(4):378-86
references: 19464088
references: Nat Rev Microbiol. 2008 Oct;6(10):776-88
references: 18794915
references: Shock. 2001 Apr;15(4):318-22
references: 11303733
references: Science. 2012 Jun 8;336(6086):1255-62
references: 22674335
references: Ann N Y Acad Sci. 2009 May;1165:338-46
references: 19538325
references: J Pediatr Gastroenterol Nutr. 2008 Aug;47 Suppl 1:S33-6
references: 18667916
references: J Trauma. 1995 Jul;39(1):44-51; discussion 51-2
references: 7636909
references: Nature. 2007 Oct 18;449(7164):804-10
references: 17943116
references: Am J Physiol Gastrointest Liver Physiol. 2008 Jan;294(1):G139-47
references: 17991705
references: Semin Respir Infect. 1994 Dec;9(4):228-31
references: 7886319
references: Surgery. 2012 Feb;151(2):278-86
references: 21145571
references: Can J Surg. 2004 Apr;47(2):109-16
references: 15132464
references: J Surg Res. 1998 Oct;79(2):91-6
references: 9758721
references: Pediatrics. 2010 Apr;125(4):777-85
references: 20308210
references: JPEN J Parenter Enteral Nutr. 1995 Nov-Dec;19(6):453-60
references: 8748359
references: Lancet. 2003 Feb 8;361(9356):512-9
references: 12583961
references: Appl Environ Microbiol. 2009 Dec;75(23):7537-41
references: 19801464
references: Ann Surg. 1994 Aug;220(2):155-63
references: 8053737
references: Clin Nutr. 2006 Apr;25(2):224-44
references: 16698152
references: Am J Physiol Gastrointest Liver Physiol. 2003 Apr;284(4):G629-37
references: 12529260
references: Ann Surg. 1992 May;215(5):503-11; discussion 511-3
references: 1616387
references: JPEN J Parenter Enteral Nutr. 1997 Jul-Aug;21(4):196-201
references: 9252944
references: J Am Coll Nutr. 1995 Dec;14(6):656-61
references: 8598428
references: Dig Dis Sci. 2002 May;47(5):1147-57
references: 12018915
references: Am J Physiol Gastrointest Liver Physiol. 2010 Jun;298(6):G833-41
references: 20299605
references: Nat Immunol. 2011 Jan;12(1):5-9
references: 21169997
references: Acta Paediatr. 2009 Feb;98(2):229-38
references: 19143664
references: Br J Surg. 1995 Dec;82(12):1663-7
references: 8548235
references: BMC Microbiol. 2008 Jul 24;8:125
references: 18652685
references: Surg Clin North Am. 2011 Aug;91(4):755-70, vii
references: 21787966
references: N Engl J Med. 1991 Aug 22;325(8):525-32
references: 1906987
references: J Physiol. 2009 Feb 1;587(3):641-54
references: 19064618
references: Proc Natl Acad Sci U S A. 2010 Aug 17;107(33):14691-6
references: 20679230
references: Crit Care Med. 2003 Apr;31(4):1118-25
references: 12682482
references: J Clin Invest. 2011 Jun;121(6):2126-32
references: 21633181
references: Ann Surg. 2005 Sep;242(3):403-9; discussion 409-12
references: 16135926
references: Infect Immun. 2010 Apr;78(4):1509-19
references: 20145094
references: Nutrition. 2004 Oct;20(10):843-8
references: 15474870
references: Nutrition. 1995 Jul-Aug;11(4):339-44
references: 8580573
references: J Pediatr Surg. 2011 Mar;46(3):577-84
references: 21376215