Background: 

Preclinical studies have reported significant changes in the gut microbiome after traumatic brain injury (TBI). We hypothesized that TBI induces the growth of Proteobacteria in the human gut. Our primary outcome was to study the profile of the human fecal microbiome after TBI and the secondary outcome was to identify colonization with colistin-resistant and multidrug-resistant pathogens.

Methods: 

Consecutive patients with moderate-severe TBI admitted to the neurotrauma-intensive care unit within 48 hours of injury were enrolled into this observational study. Samples from rectal swabs obtained on days 0, 3, and 7 after admission were assessed for microbial growth and antibiotic resistance. Demographic data and variables such as hypotension, blood transfusion, surgery, start of nasogastric feeding, use of antibiotics, length of hospital stay and mortality were noted.

Results: 

One hundred one patients were enrolled into this study; 57 (56.4%) underwent surgery, 80 (79.2%) required blood transfusion, 15 (14.9%) had an episode of hypotension, 37 (36.6%) received enteral feed within the first 3 days, and 79 (78.2%) received antibiotics. Rectal microbiological samples were collected from 101, 95, and 85 patients on days 0, 3, and 7, respectively. All organisms isolated at the 3 time-points belonged to the Proteobacteria phylum, with Enterobacteriaceae forming the largest group. Colistin-resistant organisms were found in 17 (16.8%) of 101 patients and multidrug-resistant organisms in 25 (64.1%) of the 39 patients in whom isolates were tested against the entire panel of antimicrobials.

Conclusion: 

TBI is associated with widespread colonization with Proteobacteria as early as 48 hours after injury. Colonization with colistin and multidrug-resistant organisms highlights the importance of the judicious use of antibiotics.

中文翻译：

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创伤性脑损伤后肠道微生物组的特征

背景： 

临床前研究报告称，创伤性脑损伤(TBI) 后肠道微生物组发生了显着变化。我们假设 TBI 会诱导人体肠道中变形菌的生长。我们的主要结果是研究 TBI 后人类粪便微生物组的概况，次要结果是确定粘菌素耐药和多药耐药病原体的定植。

方法： 

在受伤后 48 小时内入住神经外伤重症监护病房的连续中重度 TBI 患者被纳入这项观察性研究。对入院后第 0、3 和 7 天的直肠拭子样本进行微生物生长和抗生素耐药性评估。记录了人口统计学数据和变量，例如低血压、输血、手术、开始鼻饲、抗生素的使用、住院时间和死亡率。

结果： 

101 名患者参加了这项研究；57 人 (56.4%) 接受了手术，80 人 (79.2%) 需要输血，15 人 (14.9%) 出现低血压，37 人 (36.6%) 在前 3 天内接受肠内喂养，79 人 (78.2%) 接受抗生素治疗. 在第 0、3 和 7 天分别从 101、95 和 85 名患者中采集了直肠微生物样本。在 3 个时间点分离的所有生物体都属于变形杆菌门，其中肠杆菌科是最大的类群。在 101 名患者中有 17 名 (16.8%) 发现了粘菌素耐药生物，在对整个抗菌药物组进行分离株测试的 39 名患者中，有 25 名 (64.1%) 发现了多重耐药生物。

结论： 

早在受伤后 48 小时，TBI 就与变形杆菌的广泛定植有关。粘菌素和多重耐药生物体的定植凸显了明智使用抗生素的重要性。