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EARLの医学ノート

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敗血症をメインとした集中治療,感染症,呼吸器のノート.Stop Sepsis, Save Lives.

SIRS患者における腸内細菌叢

■広域抗菌薬使用例や早期経腸栄養を行っていない症例では何がまずいかを示すときにもってこいなのが以下の大阪大学の文献.腸管は人体の免疫の60%前後を有する最大の免疫システムであり,腸内細菌叢と腸管細胞と免疫は互いにcross-talkの関係にある.広域抗菌薬投与は腸内細菌叢の破綻をもたらし,経腸栄養を行っていない症例では腸内細菌叢撹乱,腸管細胞脱落,免疫力低下をきたすという理論が現在のスタンダードである.

■下記文献ではSIRS患者における便塗抹グラム染色所見で見た腸内細菌叢の多様性維持と予後の関係について研究した単施設前向きコホート研究である.多様性維持群,単一細菌群,細菌減少群に分け,MODS/MOFによる死亡率はそれぞれ5.9%,52.4%,64.3%であり,多様性維持群で有意に低く,便グラム染色による腸内細菌叢の確認が重症患者における状態と予後の指標となることが示されている.

■なお,広域抗菌薬(特にTAZ/PIPC(ゾシン®))を多用する病院は,患者の便中のグラム染色を見てみるとよい.腸内細菌叢がどれだけ破壊されているかが分かるはずである.これにPPIなどの胃酸抑制薬が加わることで一気に感染症リスクが増大する.

Shimizu K, Ogura H, Tomono K, Tasaki O, Asahara T, Nomoto K, Morotomi M, Matsushima A, Nakahori Y, Yamano S, Osuka A, Kuwagata Y, Sugimoto H.
Patterns of Gram-stained fecal flora as a quick diagnostic marker in patients with severe SIRS.
Dig Dis Sci. 2011 Jun;56(6):1782-8. Epub 2010 Nov 24.

Abstract

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.

AIMS: 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.
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by DrMagicianEARL | 2012-04-26 12:15 | 敗血症 | Comments(0)

by DrMagicianEARL