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Synbiotics Decrease the Incidence of Septic Complications in Patients with Severe SIRS: A Preliminary Report

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Abstract

The purpose of this study was to evaluate if synbiotic therapy can correct the deteriorated gut flora and environment in patients with severe systemic inflammatory response syndrome (SIRS). Twenty-nine SIRS patients, who fulfilled a serum C-reactive protein (CRP) level >10 mg/dl, received synbiotics (Bifidobacterium breve, Lactobacillus casei, and galactooligosaccharides) (S group) and were compared with previous observations in 26 patients without synbiotics (NS group). Analysis of fecal flora confirmed that patients in the S group had significantly greater levels of beneficial Bifidobacterium, Lactobacillus, and total organic acids (particularly short-chain fatty acids) than those in the NS group. The incidence of infectious complications such as enteritis, pneumonia, and bacteremia was significantly lower in the S group than in the NS group. Synbiotics maintain the gut flora and environment and decrease the incidence of septic complications in patients with severe SIRS. Further randomized controlled study is necessary to determine the effects of synbiotics.

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References

  1. Guarner F, Malagelada JR. Gut flora in health and disease. Lancet. 2003;361:512–519. doi:10.1016/S0140-6736(03)12489-0.

    Article  PubMed  Google Scholar 

  2. MacFie J, O’Boyle C, Mitchell CJ, Buckley PM, Johnstone D, Sudworth P. Gut origin of sepsis: a prospective study investigating associations between bacterial translocation, gastric microflora, and septic morbidity. Gut. 1999;45:223–228.

    Article  PubMed  CAS  Google Scholar 

  3. Hart A, Kamm MA. Review article: mechanisms of initiation and perpetuation of gut inflammation by stress. Aliment Pharmacol Ther. 2002;16:2017–2028. doi:10.1046/j.1365-2036.2002.01359.x.

    Article  PubMed  CAS  Google Scholar 

  4. Shimizu K, Ogura H, Goto M, et al. Altered gut flora and environment in patients with severe sirs. J Trauma. 2006;60:126–133. doi:10.1097/01.ta.0000197374.99755.fe.

    Article  PubMed  Google Scholar 

  5. Fuller R. Probiotics in man and animals. J Appl Bacteriol. 1989;66:365–378.

    PubMed  CAS  Google Scholar 

  6. Nomoto K. Prevention of infections by probiotics. J Biosci Bioeng. 2005;100:583–592. doi:10.1263/jbb.100.583.

    Article  PubMed  CAS  Google Scholar 

  7. Gibson GR. Dietary modulation of the human gut microflora using prebiotics. Br J Nutr. 1998;80:S209–S12.

    PubMed  CAS  Google Scholar 

  8. Ito M, Deguchi Y, Matsumoto K, Kimura M, Onodera N, Yajima T. Influence of galactooligosaccharides on the human fecal microflora. J Nutr Sci Vitaminol (Tokyo). 1993;39:635–640.

    CAS  Google Scholar 

  9. Rayes N, Seehofer D, Theruvath T, et al. Supply of pre- and probiotics reduces bacterial infection rates after liver transplantation—a randomized, double-blind trial. Am J Transplant. 2005;5:125–130. doi:10.1111/j.1600-6143.2004.00649.x.

    Article  PubMed  Google Scholar 

  10. Kotzampassi K, Giamarellos-Bourboulis EJ, Voudouris A, Kazamias P, Eleftheriadis E. Benefits of a synbiotic formula (synbiotic 2000forte) in critically ill trauma patients: early results of a randomized controlled trial. World J Surg. 2006;30:1848–1855. doi:10.1007/s00268-005-0653-1.

    Article  PubMed  Google Scholar 

  11. Olah A, Belagyi T, Issekutz A, Gamal ME, Bengmark S. Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis. Br J Surg. 2002;89:1103–1107. doi:10.1046/j.1365-2168.2002.02189.x.

    Article  PubMed  CAS  Google Scholar 

  12. Besselink MG, van Santvoort HC, Buskens E, et al. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet. 2008;371:651–659. doi:10.1016/S0140-6736(08)60207-X.

    Article  PubMed  Google Scholar 

  13. American college of chest physicians/society of critical care medicine consensus conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20:864–874.

    Google Scholar 

  14. Azuma R, Suto T. Validity of transfer of the taxonomical position of Corynebacterium pseudopyogenes from genus Corynebacterium to genus Actinomyces. In: Izuka H, Hasegawa T, eds. Proceeding of the First International Conference on Culture Collection. Tokyo:University of Tokyo Press, 1970:493–505.

  15. Mitsuoka T, Ono K. Fecal flora of man. V. communication: the fluctuation of the fecal flora of the healthy adult (author’s transl. Orig A). Zentralbl Bakteriol. 1977;238:228–236.

    Google Scholar 

  16. Moore WE, Cato EP, Holdeman LV. Some current concepts in intestinal bacteriology. Am J Clin Nutr. 1978;31:S33–S42.

    PubMed  CAS  Google Scholar 

  17. Tanaka R, Mutai M. Improved medium for selective isolation and enumeration of Bifidobacterium. Appl Environ Microbiol. 1980;40:866–869.

    PubMed  CAS  Google Scholar 

  18. Petts DN. Colistin-oxolinic acid-blood agar: a new selective medium for streptococci. J Clin Microbiol. 1984;19:4–7.

    PubMed  CAS  Google Scholar 

  19. Kikuchi H, Yajima T. Correlation between water-holding capacity of different types of cellulose in vitro and gastrointestinal retention time in vivo of rats. J Sci Food Agric. 1992;60:139–146. doi:10.1002/jsfa.2740600202.

    Article  CAS  Google Scholar 

  20. Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance System (NNIS). Available at http://www.cdc.gov/ncidod/dhqp/nnis_pubs.html. Accessed 21 Feb 2008.

  21. Vollaard EJ, Clasener HA. Colonization resistance. Antimicrob Agents Chemother. 1994;38:409–414.

    PubMed  CAS  Google Scholar 

  22. Moore WE, Moore LH. Intestinal floras of populations that have a high risk of colon cancer. Appl Environ Microbiol. 1995;61:3202–3207.

    PubMed  CAS  Google Scholar 

  23. Linskens RK, Huijsdens XW, Savelkoul PH, Vandenbroucke-Grauls CM, Meuwissen SG. The bacterial flora in inflammatory bowel disease: current insights in pathogenesis and the influence of antibiotics and probiotics. Scand J Gastroenterol Suppl. 2001;234:29–40. doi:10.1080/003655201753265082.

    Article  PubMed  Google Scholar 

  24. Bjorksten B. Effects of intestinal microflora and the environment on the development of asthma and allergy. Springer Semin Immunopathol. 2004;25:257–270. doi:10.1007/s00281-003-0142-2.

    Article  PubMed  Google Scholar 

  25. Furrie E, Macfarlane S, Kennedy A, et al. Synbiotic therapy (bifidobacterium longum/synergy 1) initiates resolution of inflammation in patients with active ulcerative colitis: a randomised controlled pilot trial. Gut. 2005;54:242–249. doi:10.1136/gut.2004.044834.

    Article  PubMed  CAS  Google Scholar 

  26. Liu Q, Duan ZP, Ha DK, Bengmark S, Kurtovic J, Riordan SM. Synbiotic modulation of gut flora: effect on minimal hepatic encephalopathy in patients with cirrhosis. Hepatology. 2004;39:1441–1449. doi:10.1002/hep.20194.

    Article  PubMed  Google Scholar 

  27. Kanamori Y, Hashizume K, Sugiyama M, Morotomi M, Yuki N. Combination therapy with Bifidobacterium breve, Lactobacillus casei, and galactooligosaccharides dramatically improved the intestinal function in a girl with short bowel syndrome: a novel synbiotics therapy for intestinal failure. Dig Dis Sci. 2001;46:2010–2016. doi:10.1023/A:1010611920750.

    Article  PubMed  CAS  Google Scholar 

  28. Kanazawa H, Nagino M, Kamiya S, et al. Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy. Langenbecks Arch Surg. 2005;390:104–113. doi:10.1007/s00423-004-0536-1.

    Article  PubMed  Google Scholar 

  29. Anderson AD, McNaught CE, Jain PK, MacFie J. Randomised clinical trial of synbiotic therapy in elective surgical patients. Gut. 2004;53:241–245. doi:10.1136/gut.2003.024620.

    Article  PubMed  CAS  Google Scholar 

  30. Jain PK, McNaught CE, Anderson AD, MacFie J, Mitchell CJ. Influence of synbiotic containing Lactobacillus acidophilus La5, Bifidobacterium lactis Bb 12, Streptococcus thermophilus, Lactobacillus bulgaricus and oligofructose on gut barrier function and sepsis in critically ill patients: a randomised controlled trial. Clin Nutr. 2004;23:467–475. doi:10.1016/j.clnu.2003.12.002.

    Article  PubMed  Google Scholar 

  31. Watkinson PJ, Barber VS, Dark P, Young JD. The use of pre- pro- and synbiotics in adult intensive care unit patients: systematic review. Clin Nutr. 2007;26:182–192. doi:10.1016/j.clnu.2006.07.010.

    Article  PubMed  Google Scholar 

  32. Matsuzaki T, Chin J. Modulating immune responses with probiotic bacteria. Immunol Cell Biol. 2000;78:67–73. doi:10.1046/j.1440-1711.2000.00887.x.

    Article  PubMed  CAS  Google Scholar 

  33. Asahara T, Shimizu K, Nomoto K, Hamabata T, Ozawa A, Takeda Y. Probiotic bifidobacteria protect mice from lethal infection with Shiga toxin-producing Escherichia coli O157:H7. Infect Immun. 2004;72:2240–2247. doi:10.1128/IAI.72.4.2240-2247.2004.

    Article  PubMed  CAS  Google Scholar 

  34. Asahara T, Nomoto K, Shimizu K, Watanuki M, Tanaka R. Increased resistance of mice to Salmonella enterica serovar Typhimurium infection by synbiotic administration of Bifidobacteria and transgalactosylated oligosaccharides. J Appl Microbiol. 2001;91:985–996. doi:10.1046/j.1365-2672.2001.01461.x.

    Article  PubMed  CAS  Google Scholar 

  35. Yasui H, Kiyoshima J, Hori T. Reduction of influenza virus titer and protection against influenza virus infection in infant mice fed Lactobacillus casei Shirota. Clin Diagn Lab Immunol. 2004;11:675–679. doi:10.1128/CDLI.11.4.675-679.2004.

    Article  PubMed  Google Scholar 

  36. Tsunoda A, Shibusawa M, Tsunoda Y, Watanabe M, Nomoto K, Kusano M. Effect of Lactobacillus casei on a novel murine model of abdominal sepsis. J Surg Res. 2002;107:37–43.

    PubMed  CAS  Google Scholar 

  37. Remesy C, Demigne C, Morand C. Metabolism of short chain fatty acids in the liver. In: Cummings JH, Rombeau JL, Sakata T, eds. Physiological and Clinical Aspects of Short-Chain Fatty Acids. Cambridge: Cambridge University Press; 1995:171–190.

    Google Scholar 

  38. Pryde SE, Duncan SH, Hold GL, Stewart CS, Flint HJ. The microbiology of butyrate formation in the human colon. FEMS Microbiol Lett. 2002;217:133–139. doi:10.1111/j.1574-6968.2002.tb11467.x.

    Article  PubMed  CAS  Google Scholar 

  39. Yin L, Laevsky G, Giardina C. Butyrate suppression of colonocyte NF-kappa B activation and cellular proteasome activity. J Biol Chem. 2001;276:44641–44646. doi:10.1074/jbc.M105170200.

    Article  PubMed  CAS  Google Scholar 

  40. Kanamori Y, Hashizume K, Sugiyama M, Mortomi M, Yuki N, Tanaka R. A novel synbiotic therapy dramatically improved the intestinal function of a pediatric patient with laryngotracheo-esophageal cleft (ltec) in the intensive care unit. Clin Nutr. 2002;21:527–530. doi:10.1054/clnu.2002.0593.

    Article  PubMed  CAS  Google Scholar 

  41. Fallingborg J. Intraluminal ph of the human gastrointestinal tract. Dan Med Bull. 1999;46:183–196.

    PubMed  CAS  Google Scholar 

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Acknowledgment

This work has been supported by grants from the Ministry for Education, Science, and Culture of Japan.

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Authors and Affiliations

  1. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita City, Osaka, 565-0871, Japan

    Kentaro Shimizu, Hiroshi Ogura, Miki Goto, Asako Matsushima, Osamu Tasaki, Kieko Fujita, Hideo Hosotsubo, Yasuyuki Kuwagata, Hiroshi Tanaka, Takeshi Shimazu & Hisashi Sugimoto

  2. Yakult Central Institute for Microbiological Research, 1796 Yaho, Kunitachi-shi, Tokyo, 186-0011, Japan

    Takashi Asahara, Koji Nomoto & Masami Morotomi

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  1. Kentaro Shimizu
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Correspondence to Kentaro Shimizu.

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Shimizu, K., Ogura, H., Goto, M. et al. Synbiotics Decrease the Incidence of Septic Complications in Patients with Severe SIRS: A Preliminary Report. Dig Dis Sci 54, 1071–1078 (2009). https://doi.org/10.1007/s10620-008-0460-2

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