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| 1 | Tube feeding,the microbiota,and Clostridium diff icile infection显示文摘Clostridium difficile (C. difficile) is now the leading cause of nosocomial diarrhea in the USA, accounting for 30% of patients with antibiotic-associated diarrhea, 70% of those with antibiotic-associated colitis, and most cases of pseudomembranous colitis. The organism has evolved over the last 8 years to become more virulent and resistant to antimicrobials (NAP1/027 strain) causing a more severe form of the disease that has increased mortality and healthcare costs. While it is generally accepted that the problem results from the overuse of antibiotics, and in particular second and third generation cephalosporins, fluoroquinolones and macrolides, recent studies suggest that acid suppres-sion with proton pump inhibitors (PPIs) may be equally culpable. A further common, but less recognized, etiological factor is the prolonged use of elemental diets. Such diets are totally absorbed within the small intestine and therefore deprive the colonic microbiota of their source of nutrition, namely dietary fiber, fructose oligosaccharides, and resistant starch. The resultant suppression of colonic fermentation leads to suppression of the 'good' bacteria, such as butyrate-producers (butyrate being essential for colonic mucosal health), and bifidobacteria and the creation of a 'permissive' environment for C. difficile colonization and subsequent infection. Based on this analysis, the best chance of suppressing the emerging C. difficile epidemic is to adopt a 3-pronged attack consisting of (1) avoidance of the use of prophylactic antibiotics, (2) the avoidance of prophylactic PPIs, and (3) the conversion of elemental diet feeding to a diet containing adequate indigestible carbohydrate after the first week of critical illness. In this review, we highlight the rising worldwide incidence of C. difficile associated diarrhea and the role played by non-residue diets in destabilizing the colonic microbiota. | Stephen JD O'Keefe | 2010 | World Journal of Gastroenterology2010，16，2： | 4 |
| 2 | Effect of fiber supplementation on the microbiota in critically ill patients显示文摘AIM:To determine tolerance to fiber supplementation of semi-elemental tube feeds in critically ill patients and measure its effect on colonic microbiota and fermentation.METHODS:Thirteen intensive care unit patients receiving jejunal feeding with a semi-elemental diet for predominantly necrotizing pancreatitis were studied.The study was divided into 2 parts:first,short-term (3-9 d)clinical tolerance and colonic fermentation as assessed by fecal short chain fatty acid(SCFA)concentrations and breath hydrogen and methane was measured in response to progressive fiber supplementation increasing from 4 g tid up to normal requirement levels of 8 g tid;second,4 patients with diarrhea were studied for 2-5 wk with maximal supplementation to additionally assess its influence on fecal microbiota quantitated by quantitative polymerase chain reaction (qPCR)of microbial 16S rRNA genes and Human Intestinal Tract Chip(HITChip)microarray analysis.Nearly all patients were receiving antibiotics(10/13)and acid suppressants(11/13)at some stage during the studies.RESULTS:In group 1,tolerance to progressive fiber supplementation was good with breath hydrogen and methane evidence(P=0.008 and P<0.0001,respectively)of increased fermentation with no exacerbation of abdominal symptoms and resolution of diarrhea in 2 of 4 patients.In group 2 before supplementation,fecal microbiota mass and their metabolites,SCFA,were dramatically lower in patients compared to healthy volunteers.From qPCR and HITChip analyses we calculated that there was a 97%reduction in the predominant potential butyrate producers and starch degraders.Following 2-5 wk of fiber supplementation there was a significant increase in fecal SCFA(acetate 28.4±4.1μmol/g to 42.5±3.1μmol/g dry weight,P=0.01;propionate 1.6±0.5 vs 6.22±1.1,P=0.006 and butyrate 2.5±0.6 vs 5.9±1.1,P=0.04)and microbial counts of specific butyrate producers,with resolution of diarrhea in 3 of 4 patients.CONCLUSION:Conventional management of critically ill patients,which includes the use of elemental diets and broad-spectrum antibiotics,was associated with gross suppression of the colonic microbiota and their production of essential colonic fuels,i.e.,SCFA.Our investigations show that fiber supplementation of the feeds has the potential to improve microbiota mass and function,thereby reducing the risks of diarrhea due to dysbiosis. | Stephen JD O'Keefe Junhai Ou James P DeLany Scott Curry Erwin Zoetendal H Rex Gaskins Scott Gunn | 2011 | World Journal of Gastrointestinal Pathophysiology2011，2，6： | 3 |
| 3 | Substrate specificity of the Eschc- richia coli outer membrane protease OmpT 显示文摘 | McCarter JD Stephens D Shoemaker K Rosenberg S Kitsch JF Georgiou G | 2004 | J Bacteriol2004，186，17： | 1 |
| 4 | Association of functionally dif- ferent RUNX2 p2 promoter alleles with BMD显示文摘 | Doecke JD Day C J Stephens AS | 2006 | J Bone Miner Res2006，21，2： | 1 |
| 5 | Spontaneously terminating ventricular fibrillation and asystole induce by silent ischemia causing recurrent syncope显示文摘 | Mustafa MU Baker CS Stephens JD | 1998 | Heart1998，80，： | 1 |
| 6 | The importance of long axis ventricular function显示文摘 | Brecker SJ Stephen JD | 2000 | Heart2000，84，6： | 1 |
| 7 | The importance of long axis ventricular function 显示文摘 | Brecker S J Stephen JD | 2000 | Heart2000，84，6： | 1 |
| 8 | The importance of long axis ventrieular function显示文摘 | Brecker SJ Stephen JD | 2000 | Heart2000，84，6： | 1 |
| 9 | Spatial trends of organochlorinated pesticides, polychlorinated biphenyls, and polybrominated diphenyl ethers in atlantic Anguillid eels 显示文摘 | Byer JD Lebeuf M Alaee M Stephen BR | 2013 | Chemosphere2013，90，5： | 1 |
| 10 | KIT gene mutations and copy number in melanoma subtypes显示文摘 | Carol B Erick JD Stephen HF | 2008 | Clin Cancer Res2008，14，21： | 1 |
| 11 | Influence of nicotinic acid on serum cholesterol in man显示文摘 | Altschul R Holler A Stephen JD | 1955 | J Arch Biochem Biophys1955，54，： | 1 |
| 12 | Scintigraphic Variations of normal billiary physiology显示文摘 | William W Stephens JD Strauss WE | 1984 | J Nvcl Med1984，，： | 1 |
| 13 | Association of func-tionally different RUNX2 P2 promoter alleles with BMD显示文摘 | Doceke JD Day CJ Stephen AS | 2006 | Bone Miner Res2006，21，： | 1 |
| 14 | Substrate specificity of the Escherichia coli outer membrane prote- ase OmpT显示文摘 | McCarter JD Stephens D Shoemaker K | 2004 | J Bacteriol2004，186，17： | 1 |
| 15 | Reducing bacterial counts in dental unit waterlines: tap water versus distilled water 显示文摘 | Kettering JD Stephens JA Munoz-Viveros CA | 2002 | J Contemp Dent Pract2002，3，3： | 1 |
| 16 | WholePathwayScope:a comprehensive pathwaybased analysis tool for high-throughput data显示文摘 | Yi M Horton JD Cohen JC Hobbs HH Stephens RM | | 0，，： | 1 |
| 17 | Acute left ventricular remodeling following myocardial infarction:coupling of regional healing with remote extracellular matrix expansion显示文摘 | William C Stephen JD David AW | 2012 | JACC:Cardiovasc Imaging2012，5，9： | 1 |
| 18 | Medialization of the subscapularis footprint does not affect functional outcome of arthroscopic repair显示文摘 | Patrick JD Stephen SB | 2012 | Arthroscopy2012，28，11： | 1 |
| 19 | Structure and activity of an active site substitution of ricin A chain 显示文摘 | Philip JD Stephen RE Arthur EF | 1996 | Biochemistry1996，35，11： | 1 |
| 20 | Comparison of the effects of three insulinotropic drugs on plasma insulin levels after a standard meal显示文摘 | Lawrence SC Stephen DL Gareth JD | 2002 | Diabetes Care2002，25，： | 1 |
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