Association between postoperative changes in the gut microbiota and pseudopsia after cardiac surgery: prospective observ
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RESEARCH ARTICLE
Association between postoperative changes in the gut microbiota and pseudopsia after cardiac surgery: prospective observational study Masaki Maekawa1, Kenji Yoshitani1* , Musashi Yahagi1, Takashi Asahara2, Yoshiyuki Shishido2, Satsuki Fukushima3, Naoki Tadokoro3, Tomoyuki Fujita3 and Yoshihiko Ohnishi1
Abstract Background: Delirium after cardiac surgery affects mortality, but the mechanism remains unclear. Previous studies have reported gut microbiota are associated with brain activity. Systemic inflammation and antibiotics can damage the gut microbiota after cardiac surgery. We aimed to investigate changes in the gut microbiota and the association between the gut microbiota and delirium after cardiac surgery. Methods: Twenty-one patients who underwent cardiac surgery were enrolled. Microbiota counts and fecal organic acid concentrations were measured in fecal samples harvested before surgery, just after surgery, and before discharge. To quantify the microbiota, we extracted total RNA fractions and examined gut microbiota composition using 16S and 23S rRNA-targeted quantitative-reverse Transcription-PCR. Postoperative delirium, insomnia, and pseudopsia were assessed for 1 week. Postoperative total bacterial counts changed significantly from 10.2 ± 0.2 log10 cells/g of feces to 9.8 ± 0.5 in the first postoperative samples (p = 0.003) and 10.0 ± 0.4 in the samples before discharge (p = 0.039). Fecal pH was 6.9 ± 0.6 before surgery and 7.4 ± 0.7 in the first postoperative samples (p = 0.001). Postoperative Staphylococcus and Pseudomonas counts were significantly higher in patients with postoperative pseudopsia than in patients without pseudopsia (3.2 ± 1.3 vs. 5.4 ± 0.9; p = 0.012 and 1.7 ± 0.8 vs. 4.6 ± 2.7; p = 0.001). Conclusions: Total bacterial counts were significantly lower after surgery and until discharge. Fecal pH was significantly higher than preoperative levels. Staphylococcus and Pseudomonas counts were significantly higher in patients with postoperative pseudopsia. Keywords: Delirium, Microbiota, Gut–brain axis, Cardiac surgery Background Postoperative delirium after cardiac surgery is a serious complication and an independent predictor of worse prognosis [1]. Some studies have reported risk factors for delirium, such as age and inflammation [2, 3]. *Correspondence: [email protected] 1 Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Japan Full list of author information is available at the end of the article
However, details about postoperative delirium remain to be clarified. Previous studies have demonstrated that individual differences in the gut microbiota influence health status [4, 5] as well as brain activity, which is referred to as microbiota–gut–brain communication [6, 7]. Patients who undergo cardiac surgery with cardiopulmonary bypass who develop systemic inflammation [8] and receive multiple drugs experience damage to their gut flora [9, 10]. Some studies claim that damaged gut flora may lead to
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