What does the microbiota have to do with hospital admissions? It certainly has something to do with it, and this was demonstrated by a Dutch study that investigated two large groups of patients in Europe, finding that for every 10% increase in bacteria that produce buttyrate, the risk of hospitalization for infections decreases by between 14 and 25 percent. %. The study, which will be presented at the April congress of Eccmid (European Congress of Clinical Microbiology and Infectious Diseases) in Barcelona, was conducted by Robert Kullberg and colleagues at the Amsterdam University Medical Center.
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But let’s take a step back: alterations in the microbiota are common in patients hospitalized for severe infections and preclinical models have shown that anaerobic butyrate-producing bacteria protect against systemic infections. These bacteria were studied because they are practically zero in patients hospitalized for severe infections and because butyrate can have protective effects in other serious non-infectious intestinal diseases.
Two great studies
Although the relationship between microbiota imbalance and increase in severe infections is not clear, in this study the authors instead investigated the relationship between basal microbiota and risk of future hospitalizations for infections in two large population studies, the Danish Helius and the Finnish Finrisk 2002.
The intestinal microbiota was characterized by sequencing the DNA of the bacteria to identify the different types of bacteria present in the participants’ feces. The authors then measured the composition of the microbiota, the diversity and quantity of butyrate-producing bacteria and used statistical models to take into account other variables such as lifestyle, exposure to antibiotics, and other diseases.
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The researchers profiled the microbiota of 10,699 participants. A total of 602 people had been hospitalized or died from infections, mostly pneumonia, during follow-up. The gut microbiota of hospitalized and deceased patients differed from all others. And indeed, every 10% higher percentage of bacteria producing butyrate was associated with a lower risk of hospitalization for infections of all types by 25% in the Danish group and 14% in the Finnish group (and who knows why…). These associations remained the same, even after expected adjustments.
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“A good composition of the intestinal microbiota – explain the authors – in particular a specific colonization with bacteria that produce butyrate, is associated with protection against hospitalization for infectious diseases in the general population, according to two independent European cohorts. And now other studies will evaluate whether modulation of the microbiome can reduce the risk of severe infections.” Further analyzes will be needed before starting studies on patients. One of the challenges is that the bacteria that produce butyrate are anaerobic, meaning they do not use oxygen to live and in fact do not tolerate it. Which makes it very difficult to transport viable bacteria into the intestine. Many research groups are working to address these challenges.
Italian research
And one, the Italian one from Cattolica, published a few years ago on Annals of Internal Medicine a study that goes in the same direction as the Dutch one. “About five years ago we demonstrated – he says Gianluca Ianiro, researcher of Digestive System Diseases at the Catholic University of Rome – that a fecal transplant in which you put healthy flora with many bacteria that produce butyrate reduces the risk of septicemia and death in patients with Clostridium difficile. This is because butyrate is a short-chain fatty acid that is useful for cell repair and protects the intestinal barrier.”
Butyrate-producing bacteria are stimulated by inulin. “but it wouldn’t make sense to think about giving everyone inulin. The microbiome must have an adequate diversity of bacteria, in the sense of variety, and there must be a balance between the species of microbial groups, with a good presence of anti-inflammatory bacteria and low presence of the pro-inflammatory ones.”
Diet as a modulator of the microbiome
Diet is an excellent modulator of the microbiome in the long run, even if other elements, such as breastfeeding, antibiotic therapies, colon interventions have an impact. “An adequate diet contributes to the health of the microbiota – concludes Ianiro – therefore prebiotic fibers such as Kefir or yogurt, vegetables, in particular asparagus and chicory, vegetables rich in inulin, and avoiding some diets such as the no fodmap, indicated for some intestinal pathologies, which but they have too low a level of fibre.”
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– 2024-04-01 00:47:41
