Impact of Fiber-Based Enteral Nutrition on the Gut Microbiome of ICU Patients Receiving Broad-Spectrum Antibiotics: A Randomized Pilot Trial.
Impact of Fiber-Based Enteral Nutrition on the Gut Microbiome of ICU Patients Receiving Broad-Spectrum Antibiotics: A Randomized Pilot Trial.
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DOI：
10.1097/cce.0000000000000135
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发表时间：
2020-06-01
影响因子：
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通讯作者：
Munck, Christian
中科院分区：
文献类型：
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作者：
Freedberg, Daniel E;Messina, Megan;Munck, Christian
目的：膳食纤维增加了将纤维代谢成短链脂肪酸的细菌的丰度，并赋予对多重耐药细菌肠道定植的抵抗力。设计：随机、对照、开放标签试验。地点：内科ICU。患者：20名ICU成人，接受广谱IV抗生素治疗脓毒症。干预：1：1随机分配至含大豆和燕麦混合纤维的肠内营养（14.3g纤维/L）与含0 g/L纤维的卡路里和微量营养素相同的肠内营养相比。在基线和研究第3、7、14和30天采集直肠拭子和全粪便。主要结局是根据直肠拭子16 S测序，从基线到第3天产生短链脂肪酸的分类群的累积相对丰度的个体内变化。次要结局是基于全粪便质谱的第3天累积短链脂肪酸水平。主要结果：到第3天，纤维组累积接受的纤维中位数为32.1g（四分位数范围，17.6-54.6），而无纤维组为0 g（四分位数范围，0-4.0）。从基线到第3天，短链脂肪酸生产者相对丰度的个体内中位数变化在纤维组中为+61%（四分位距为-51至+1，688），而在无纤维组中为-46%（四分位距为-78至+13）（p = 0.28）。第3天全粪便短链脂肪酸水平中位数为707 μ g短链脂肪酸/g粪便（四分位数范围，190- 7，265）与118 μ g短链脂肪酸/g粪便（四分位距，22- 1，195），无纤维组（p = 0.16）。肠纤维与ICU患者中短链脂肪酸产生菌相对丰度增加和短链脂肪酸水平增加的非显著趋势相关，第四类抗生素。应该进行更大规模的研究，我们的结果可以用于效应量估计。
OBJECTIVES: Dietary fiber increases the abundance of bacteria that metabolize fiber into short-chain fatty acids and confers resistance against gut colonization with multidrug-resistant bacteria. This pilot trial estimated the effect of fiber on gut short-chain fatty acid-producing bacteria in the ICU.DESIGN: Randomized, controlled, open label trial.SETTING: Medical ICU.PATIENTS: Twenty ICU adults receiving broad-spectrum IV antibiotics for sepsis.INTERVENTION: 1:1 randomization to enteral nutrition with mixed soy- and oat-derived fiber (14.3g fiber/L) versus calorie- and micronutrient-identical enteral nutrition with 0g/L fiber.MEASUREMENTS: Rectal swabs and whole stools were collected at baseline and on study Days 3, 7, 14, and 30. The primary outcome was within-individual change in the cumulative relative abundance of short-chain fatty acid-producing taxa from baseline to Day 3 based on 16S sequencing of rectal swabs. The secondary outcome was Day 3 cumulative short-chain fatty acid levels based on mass spectrometry of whole stools. Analyses were all intent to treat.MAIN RESULTS: By Day 3, the fiber group received a median of 32.1g fiber cumulatively (interquartile range, 17.6-54.6) versus 0g fiber (interquartile range, 0-4.0) in the no fiber group. The median within-individual change in short-chain fatty acid producer relative abundance from baseline to Day 3 was +61% (interquartile range -51 to +1,688) in the fiber group versus -46% (interquartile range, -78 to +13) in the no fiber group (p = 0.28). Whole stool short-chain fatty acid levels on Day 3 were a median of 707 mug short-chain fatty acids/g stool (interquartile range, 190-7,265) in the fiber group versus 118 mug short-chain fatty acids/g stool (interquartile range, 22-1,195) in the no fiber group (p = 0.16).CONCLUSIONS: Enteral fiber was associated with nonsignificant trends toward increased relative abundance of short-chain fatty acid-producing bacteria and increased short-chain fatty acid levels among ICU patients receiving broad-spectrum IV antibiotics. Larger studies should be undertaken and our results can be used for effect size estimates.