Ch 4: Gut Microbiota

Question 1

Which probitoic should be considered in pouchitis?

Answer 1

In pouchitis, probiotic supplementation with VSL #3 shows promise in reducing patients time to remission in episodes of active acute pouchitis and in delaying remission when taken in rotation with antibiotic regimens

Question 2

What is ASPEN/SSCM stance of probiotic use?

Answer 2

ASPEN and SCCM state that the use of identified probiotics species and strains seem to be safe in general ICU patients, but they should be used only for the select medical and surgical patients for which RCTs have documented safety and outcome benefit (i.e vent associated PNA, liver transplant)

Question 3

What is ASPEN/SCCM guidelines for fermentable soluble fiber in critical illness?

Answer 3

APEN/SCCM guidelines for nutrition support in critically ill patients suggest that a fermentable soluble fiber additive (ex: FOS, inulin) be considered for routine use in all hemodynamically stable medical ICU and surgical ICU patients receiving a standard enteral formula.

The guidelines suggest 10-20 g fermentable soluble fiber supplemental be given in divided doses over 24 hours as adjudicative therapy if there is evidence of diarrhea

Question 4

What is the evidence for using probiotics with Crohn’s disease?

Answer 4

Evidence for the effectiveness of pre and probiotics in Crohn’s disease remains inconclusive.

Question 5

Which antibiotic is typically used to treat C Diff?

Answer 5

C Diff is typically treated with metronidazole (Flagyl) initially. The treatment is repeated in patients that fail initial treatment; if they relapse again, they are then treated with oral vancomycin.

Question 6

Which probiotics are more often used in UC trial?

Answer 6

Escherichia coli Nissle 1917 and VSL#3 are used in most UC trials, though more research is needed

Question 7

What are some of the risk factors associated with developing AAD/CDAD?

Answer 7

Severe illness, advanced age, presence of NGT, provision of medications to raise gastric pH, GI surgery/manipulation, immunocompromised status, and extended hospital stay.

Question 8

Which probiotic seems to exhibit the best protection from antibiotic associated diarrhea?

Answer 8

Saccharomyces boulardii, LGG, and probiotic mixtures

Question 9

Which probiotic significantly reduced C Diff recurrence in patients with were also receiving high dose oral vancomycin?

Answer 9

S. Boulardii significantly reduced C Diff recurrence in patients with were also receiving high dose oral vancomycin.

Question 10

Which antibiotics are most likely to cause C Diff?

Answer 10

Fluoroquinolones:
Ciprofloxacin (Cipro)
Gemifloxacin (Factive)
Levofloxacin (Levaquin)
Moxifloxacin (Avelox)
Norfloxacin (Noroxin)
Ofloxacin (Floxin)

Question 11

What are the contraindications to administering a probiotic in a critically ill patient?

Answer 11

Hemodynamic instability

Use with caution with IV catheters, antibiotic therapy, short gut, leukemia, mitral regurgitation, and cardiac surgery

Question 12

When does antibiotic associated diarrhea usually occur?

Answer 12

4-9 days following antibiotic cessation, but can occur up to 8 weeks later