Gut barrier dysfunction and the risk of ICU-acquired bacteremia- a case–control study
Abstract Background Impaired intestinal barrier function can enable passage of enteric microorganisms into the bloodstream and lead to nosocomial bloodstream infections during critical illness. We aimed to determine the relative importance of gut translocation as a source for ICU-acquired enterococc...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2024-03-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-024-01280-8 |
| _version_ | 1827300835776790528 |
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| author | Meri R. J. Varkila Diana M. Verboom Lennie P. G. Derde Tom van der Poll Marc J. M. Bonten Olaf L. Cremer the MARS consortium |
| author_facet | Meri R. J. Varkila Diana M. Verboom Lennie P. G. Derde Tom van der Poll Marc J. M. Bonten Olaf L. Cremer the MARS consortium |
| author_sort | Meri R. J. Varkila |
| collection | DOAJ |
| description | Abstract Background Impaired intestinal barrier function can enable passage of enteric microorganisms into the bloodstream and lead to nosocomial bloodstream infections during critical illness. We aimed to determine the relative importance of gut translocation as a source for ICU-acquired enterococcal bacteremia of unknown origin. Methods We conducted a nested case–control study in two mixed medical-surgical tertiary ICUs in the Netherlands among patients enrolled between 2011 and 2018. We selected 72 cases with ICU-acquired bacteremia due to enterococci (which are known gastrointestinal tract commensals) and 137 matched controls with bacteremia due to coagulase-negative staphylococci (CoNS) (which are of non-intestinal origin). We measured intestinal fatty acid-binding protein, trefoil factor-3, and citrulline 48 h before bacteremia onset. A composite measure for Gut Barrier Injury (GBI) was calculated as the sum of standardized z-scores for each biomarker plus a clinical gastrointestinal failure score. Results No single biomarker yielded statistically significant differences between cases and controls. Median composite GBI was higher in cases than in controls (0.58, IQR − 0.36–1.69 vs. 0.32, IQR − 0.53–1.57, p = 0.33) and higher composite measures of GBI correlated with higher disease severity and ICU mortality (p < 0.001). In multivariable analysis, higher composite GBI was not significantly associated with increased occurrence of enterococcal bacteremia relative to CoNS bacteremia (adjusted OR 1.12 95% CI 0.93–1.34, p = 0.22). Conclusions We could not demonstrate an association between biomarkers of gastrointestinal barrier dysfunction and an increased occurrence of bacteremia due to gut compared to skin flora during critical illness, suggesting against bacterial translocation as a major vector for acquisition of nosocomial bloodstream infections in the ICU. |
| first_indexed | 2024-04-24T16:12:52Z |
| format | Article |
| id | doaj.art-184a0a24672c4ca9bd68f8cca75118fb |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-04-24T16:12:52Z |
| publishDate | 2024-03-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-184a0a24672c4ca9bd68f8cca75118fb2024-03-31T11:35:29ZengSpringerOpenAnnals of Intensive Care2110-58202024-03-0114111010.1186/s13613-024-01280-8Gut barrier dysfunction and the risk of ICU-acquired bacteremia- a case–control studyMeri R. J. Varkila0Diana M. Verboom1Lennie P. G. Derde2Tom van der Poll3Marc J. M. Bonten4Olaf L. Cremer5the MARS consortiumJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityDepartment of Intensive Care Medicine, University Medical Center UtrechtCenter for Experimental and Molecular Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, University of AmsterdamJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityAbstract Background Impaired intestinal barrier function can enable passage of enteric microorganisms into the bloodstream and lead to nosocomial bloodstream infections during critical illness. We aimed to determine the relative importance of gut translocation as a source for ICU-acquired enterococcal bacteremia of unknown origin. Methods We conducted a nested case–control study in two mixed medical-surgical tertiary ICUs in the Netherlands among patients enrolled between 2011 and 2018. We selected 72 cases with ICU-acquired bacteremia due to enterococci (which are known gastrointestinal tract commensals) and 137 matched controls with bacteremia due to coagulase-negative staphylococci (CoNS) (which are of non-intestinal origin). We measured intestinal fatty acid-binding protein, trefoil factor-3, and citrulline 48 h before bacteremia onset. A composite measure for Gut Barrier Injury (GBI) was calculated as the sum of standardized z-scores for each biomarker plus a clinical gastrointestinal failure score. Results No single biomarker yielded statistically significant differences between cases and controls. Median composite GBI was higher in cases than in controls (0.58, IQR − 0.36–1.69 vs. 0.32, IQR − 0.53–1.57, p = 0.33) and higher composite measures of GBI correlated with higher disease severity and ICU mortality (p < 0.001). In multivariable analysis, higher composite GBI was not significantly associated with increased occurrence of enterococcal bacteremia relative to CoNS bacteremia (adjusted OR 1.12 95% CI 0.93–1.34, p = 0.22). Conclusions We could not demonstrate an association between biomarkers of gastrointestinal barrier dysfunction and an increased occurrence of bacteremia due to gut compared to skin flora during critical illness, suggesting against bacterial translocation as a major vector for acquisition of nosocomial bloodstream infections in the ICU.https://doi.org/10.1186/s13613-024-01280-8BacteremiaIntensive care unitBloodstream infectionBacterial translocationGut barrierGastrointestinal failure |
| spellingShingle | Meri R. J. Varkila Diana M. Verboom Lennie P. G. Derde Tom van der Poll Marc J. M. Bonten Olaf L. Cremer the MARS consortium Gut barrier dysfunction and the risk of ICU-acquired bacteremia- a case–control study Annals of Intensive Care Bacteremia Intensive care unit Bloodstream infection Bacterial translocation Gut barrier Gastrointestinal failure |
| title | Gut barrier dysfunction and the risk of ICU-acquired bacteremia- a case–control study |
| title_full | Gut barrier dysfunction and the risk of ICU-acquired bacteremia- a case–control study |
| title_fullStr | Gut barrier dysfunction and the risk of ICU-acquired bacteremia- a case–control study |
| title_full_unstemmed | Gut barrier dysfunction and the risk of ICU-acquired bacteremia- a case–control study |
| title_short | Gut barrier dysfunction and the risk of ICU-acquired bacteremia- a case–control study |
| title_sort | gut barrier dysfunction and the risk of icu acquired bacteremia a case control study |
| topic | Bacteremia Intensive care unit Bloodstream infection Bacterial translocation Gut barrier Gastrointestinal failure |
| url | https://doi.org/10.1186/s13613-024-01280-8 |
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