Correlation between secondary infection and intestinal flora in patients with sepsis

Wei Mingjun; Hu Xiyi; Zheng Laizan; Wang Yiping; Chen Longwang; Wu Bin; Lu Zhongqiu

doi:10.3969/j.issn.1672-8521.2025.02.003

Abstract：Objective:To evaluate the incidence of secondary infection,risk factors and predictive value of intestinal flora in patients with sepsis.Methods:A total of 97 patients with sepsis admitted to the First Affiliated Hospital of Wenzhou Medical University and underwent 16s rRNA sequencing of intestinal flora from April to December 2021 were selected,and their clinical data were retrospectively analyzed.They were divided into secondary infection group(13 cases)and non-secondary infection group(84 cases)based on whether there was a secondary infection of sepsis.The rectal swab specimens of the patients were collected within 30 minutes after entering the emergency intensive unit and the intestinal flora was sequenced by 16s rRNA.The demographic and clinical characteristics of patients were collected.Binary Logistic regression was used to analyze the risk factors for secondary infection.Key microflora of different types of samples were analyzed and selected by linear discriminant analysis effect size(LEfSe)method,and the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of related clinical characteristics and intestinal flora for secondary infection in sepsis.Results:Compared with the two groups,the length of hospital stay,tracheal intubation,gastric tube placement rate of patients with sepsis secondary infection were significantly increased.The total length of hospital stay and gastric tube indwelling were independently associated with secondary infection.There was no significant difference in community diversity and evenness between the two groups.Jansen-shannon distance(JSD)clustering method suggested that Fingoldelia was the most enriched genus in intestinal type 1.Enterococcus was the most enriched genus in intestinal type 2.LEfSe analysis indicated that there were significant differences in the composition of the intestinal microbiota at the phylum,class,order,family and genus levels between the two groups.Spearman correlation analysis showed that Faecalibacterium,Anaerococcus,Corynebacterium,Peptostreptococcus were less common in females than in males;Anaerococcus was negatively correlated with the length of stay in the emergency intensive care unit(EICU);Lactobacillus was positively correlated with Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,Faecalibacterium,Anaerococcus,Corynebacterium,Peptostreptococcus were positively correlated with smoking history,Enterococcus was positively correlated with diabetes history;Anaerococcus was positively correlated with central venous catheterization;Anaerococcus and Faecalibacterium were positively correlated with tracheal intubation;Anaerococcus,Faecalibacterium and Peptostreptococcus were positively correlated with gastric tube indwelling,and Anaerococcus was positively correlated with urinary catheter indwelling.According to the LEfSe analysis,Actinobacillus and Campylobacter were selected to draw receiver operating characteristic(ROC)curve,and the area under the ROC curve was 0.779.Conclusions:Invasive treatment and the length of stay have great influence on various barrier functions and bacterial colonization,which may increase the incidence of secondary infection.Eggerthella and Enterorhabdus may be associated with secondary infections in sepsis patients,while Akkermansia protective role in the gut may reduce the incidence of secondary infections in sepsis patients.Detection of Dalyellia and Campylobacter on admission has a certain predictive effect on the assessment of secondary infections in patients with sepsis.