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出境医 / 临床实验 / Evolution of Oropharyngeal and Rectal Microbiota After Severe Traumatic Brain Injury (BBAX)

Evolution of Oropharyngeal and Rectal Microbiota After Severe Traumatic Brain Injury (BBAX)

Study Description
Brief Summary:

Modifications of the human gut microbiota have been associated with different pathological conditions such as obesity, inflammatory bowel diseases and neurodegenerative diseases. Recently the " Brain-Gut Axis ", a bidirectional communication axis between brain and gut, has been described. In recent animal studies, an acute brain injury was associated with rapid modifications of the gut microbiota.

In humans, traumatic brain injury (TBI) is a leading cause of death and disability. The patterns of gut and oropharyngeal microbiota following TBI are unknown. The primary purpose of this study is to characterize gut and oropharyngeal microbiota of patients with severe TBI.


Condition or disease Intervention/treatment
Traumatic Brain Injury Multiple Trauma Procedure: Oropharyngeal swab Procedure: Rectal swab Procedure: Disability rating scale (DRS-F)

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Study Design
Layout table for study information
Study Type : Observational
Estimated Enrollment : 50 participants
Observational Model: Case-Control
Time Perspective: Prospective
Official Title: From the Brain to the Bugs: Evolution of Oropharyngeal and Rectal Microbiota of Patients With Severe Traumatic Brain Injury Admitted in ICU
Actual Study Start Date : April 21, 2019
Estimated Primary Completion Date : April 2021
Estimated Study Completion Date : October 2021
Arms and Interventions
Group/Cohort Intervention/treatment
Patients with isolated severe traumatic brain injury (TBI)
TBI with initial Glasgow Coma Scale (GCS) ≤ 8 and AISextrahead score ≤3. Oropharyngeal and rectal swabs will be performed for each patient within the first 24 hours after ICU admission (day 0), then 48 hours (day 2) and 7 days (day 7) after ICU admission and weekly thereafter until ICU discharge.
Procedure: Oropharyngeal swab
Will be performed by trained paramedical staff using sterile swabs with transport medium ESwab® (Becton, Dickinson and Company, New Jersey, USA). Swabs will be stored at -80°C until DNA extraction.

Procedure: Rectal swab
Will be performed by trained paramedical staff using sterile swabs with transport medium ESwab® (Becton, Dickinson and Company, New Jersey, USA). Swabs will be stored at -80°C until DNA extraction.

Procedure: Disability rating scale (DRS-F)
Will be assessed at day 90 +/- 7 days.

Patients with severe trauma without TBI
Patients with severe trauma without TBI (AISextrahead score > 3). Oropharyngeal and rectal swabs will be performed for each patient within the first 24 hours after ICU admission (day 0), then 48 hours (day 2) and 7 days (day 7) after ICU admission and weekly thereafter until ICU discharge.
Procedure: Oropharyngeal swab
Will be performed by trained paramedical staff using sterile swabs with transport medium ESwab® (Becton, Dickinson and Company, New Jersey, USA). Swabs will be stored at -80°C until DNA extraction.

Procedure: Rectal swab
Will be performed by trained paramedical staff using sterile swabs with transport medium ESwab® (Becton, Dickinson and Company, New Jersey, USA). Swabs will be stored at -80°C until DNA extraction.

Procedure: Disability rating scale (DRS-F)
Will be assessed at day 90 +/- 7 days.

Healthy Controls

Persons who have not had the conditions being studied or otherwise related conditions or symptoms, as specified in the eligibility requirements.

Oropharyngeal and rectal swabs will be taken only once, at inclusion, after that the participation of the control individual in the trial will be completed.

Procedure: Oropharyngeal swab
Will be performed by trained paramedical staff using sterile swabs with transport medium ESwab® (Becton, Dickinson and Company, New Jersey, USA). Swabs will be stored at -80°C until DNA extraction.

Procedure: Rectal swab
Will be performed by trained paramedical staff using sterile swabs with transport medium ESwab® (Becton, Dickinson and Company, New Jersey, USA). Swabs will be stored at -80°C until DNA extraction.

Outcome Measures
Primary Outcome Measures :
  1. Change in microbiota alpha-diversity as measured by Shannon index [ Time Frame: From day 0 to day 90 ]
    The oropharyngeal and rectal swabs, performed at day 0, day 2, day 7 after ICU admission and weekly thereafter until ICU discharge or no later than day 90, will be used for DNA extraction and the bacterial 16S rRNA amplification and sequencing in order to identify the bacterial species colonizing the gut.


Secondary Outcome Measures :
  1. Alpha and beta-diversities of oropharyngeal and rectal microbiota at different times post trauma. [ Time Frame: From day 0 to day 90 ]
    The oropharyngeal and rectal swabs, performed at day 0, day 2, day 7 after ICU admission and weekly thereafter until ICU discharge or no later than day 90, will be used for DNA extraction and the bacterial 16S rRNA amplification and sequencing in order to identify the bacterial species.

  2. ICU-acquired infections [ Time Frame: From day 0 to day 90 ]
    The ICU-acquired infection rates during the ICU stay

  3. Number of patients acquiring colonization or infection with multidrug resistant bacteria during ICU stay [ Time Frame: From day 0 to day 90 ]
    Multidrug resistant bacteria colonisation or infection acquired during the ICU stay

  4. Death at ICU discharge and 90 days post trauma. [ Time Frame: From day 0 to day 90 ]
    The rates of deaths at ICU discharge and 90 days post trauma

  5. Disability Rating Scale (DRS-F) score at 90 days post trauma [ Time Frame: From day 0 to day 90 ]
    Neurological outcome at 90 days post trauma evaluated by the Disability Rating Scale, the French translation (DRS-F) quoted from 0 (no disability) to 29 (extreme vegetative state)


Biospecimen Retention:   Samples With DNA

Biospecimen types :

  • Oropharyngeal swabs
  • Rectal swabs

The swabs will be performed for each patient within the first 24 hours after ICU admission (day 0), then 48 hours (day 2) and 7 days (day 7) after ICU admission and weekly thereafter until ICU discharge. Rectal and oropharyngeal swabs will be performed by trained paramedical staff using sterile swabs with transport medium ESwab® (Becton, Dickinson and Company, New Jersey, USA). Swabs will be stored at -80°C until bacterial DNA extraction.


Eligibility Criteria
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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population
Patients who are 18 years of age or older, admitted to intensive care unit for severe trauma.
Criteria

Inclusion Criteria:

  • Admission to Bicêtre Hospital Trauma Center for severe trauma with:

either isolated severe traumatic brain injury (TBI): TBI with initial Glasgow Coma Scale (GCS) ≤ 8 and AISextrahead score ≤3; either severe trauma without TBI (AISextrahead score > 3)

  • Estimated ICU length of stay 48 hours or more

Exclusion Criteria:

  • Antimicrobial therapy within the previous 3 months
  • Long-term corticosteroids use
  • Active cancer
  • Institutionalized patient
  • Gastro-intestinal perforation or emergency gastro-intestinal surgery following trauma
  • Withdrawal of consent
  • Patient under guardianship
  • Pregnant or breastfeeding women
Contacts and Locations

Contacts
Layout table for location contacts
Contact: Samy Figueiredo, MD, PhD +33 (0)145213441 samy.figueiredo@aphp.fr

Locations
Layout table for location information
France
APHP Bicêtre Hospital Recruiting
Le Kremlin-Bicetre, France, 94270
Contact: Samy FIGUEIREDO, MD, PhD    +33 (0)145213441    samy.figueiredo@aphp.fr   
Sponsors and Collaborators
Assistance Publique - Hôpitaux de Paris
Paris-Saclay University
Investigators
Layout table for investigator information
Principal Investigator: Samy Figueiredo, MD, PhD Assistance Publique - Hôpitaux de Paris
Tracking Information
First Submitted Date May 24, 2019
First Posted Date May 29, 2019
Last Update Posted Date March 2, 2021
Actual Study Start Date April 21, 2019
Estimated Primary Completion Date April 2021   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures
 (submitted: May 24, 2019)
Change in microbiota alpha-diversity as measured by Shannon index [ Time Frame: From day 0 to day 90 ]
The oropharyngeal and rectal swabs, performed at day 0, day 2, day 7 after ICU admission and weekly thereafter until ICU discharge or no later than day 90, will be used for DNA extraction and the bacterial 16S rRNA amplification and sequencing in order to identify the bacterial species colonizing the gut.
Original Primary Outcome Measures Same as current
Change History
Current Secondary Outcome Measures
 (submitted: June 18, 2019)
  • Alpha and beta-diversities of oropharyngeal and rectal microbiota at different times post trauma. [ Time Frame: From day 0 to day 90 ]
    The oropharyngeal and rectal swabs, performed at day 0, day 2, day 7 after ICU admission and weekly thereafter until ICU discharge or no later than day 90, will be used for DNA extraction and the bacterial 16S rRNA amplification and sequencing in order to identify the bacterial species.
  • ICU-acquired infections [ Time Frame: From day 0 to day 90 ]
    The ICU-acquired infection rates during the ICU stay
  • Number of patients acquiring colonization or infection with multidrug resistant bacteria during ICU stay [ Time Frame: From day 0 to day 90 ]
    Multidrug resistant bacteria colonisation or infection acquired during the ICU stay
  • Death at ICU discharge and 90 days post trauma. [ Time Frame: From day 0 to day 90 ]
    The rates of deaths at ICU discharge and 90 days post trauma
  • Disability Rating Scale (DRS-F) score at 90 days post trauma [ Time Frame: From day 0 to day 90 ]
    Neurological outcome at 90 days post trauma evaluated by the Disability Rating Scale, the French translation (DRS-F) quoted from 0 (no disability) to 29 (extreme vegetative state)
Original Secondary Outcome Measures
 (submitted: May 24, 2019)
  • Alpha and beta-diversities of oropharyngeal and rectal microbiota at different times post trauma. [ Time Frame: From day 0 to day 90 ]
    The oropharyngeal and rectal swabs, performed at day 0, day 2, day 7 after ICU admission and weekly thereafter until ICU discharge or no later than day 90, will be used for DNA extraction and the bacterial 16S rRNA amplification and sequencing in order to identify the bacterial species.
  • ICU-acquired infections [ Time Frame: From day 0 to day 90 ]
    The ICU-acquired infection rates during the ICU stay
  • Multidrug resistant bacteria colonisation or infection [ Time Frame: From day 0 to day 90 ]
    Multidrug resistant bacteria colonisation or infection acquired during the ICU stay
  • Death at ICU discharge and 90 days post trauma. [ Time Frame: From day 0 to day 90 ]
    The rates of deaths at ICU discharge and 90 days post trauma
  • DRS-F score at 90 days post trauma [ Time Frame: From day 0 to day 90 ]
    Neurological outcome (disability rating scale) at 90 days post trauma
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title Evolution of Oropharyngeal and Rectal Microbiota After Severe Traumatic Brain Injury
Official Title From the Brain to the Bugs: Evolution of Oropharyngeal and Rectal Microbiota of Patients With Severe Traumatic Brain Injury Admitted in ICU
Brief Summary

Modifications of the human gut microbiota have been associated with different pathological conditions such as obesity, inflammatory bowel diseases and neurodegenerative diseases. Recently the " Brain-Gut Axis ", a bidirectional communication axis between brain and gut, has been described. In recent animal studies, an acute brain injury was associated with rapid modifications of the gut microbiota.

In humans, traumatic brain injury (TBI) is a leading cause of death and disability. The patterns of gut and oropharyngeal microbiota following TBI are unknown. The primary purpose of this study is to characterize gut and oropharyngeal microbiota of patients with severe TBI.

Detailed Description

Study Protocol :

Observational prospective cohort study.

Patients

Patients admitted to the ICU for severe trauma will be included. Two groups of patients with severe trauma will be studied:

  1. Patients with isolated severe traumatic brain injury (TBI): TBI with initial Glasgow Coma Scale (GCS) ≤ 8 and AISextrahead score ≤3
  2. Patients with severe trauma without TBI (AISextrahead score > 3)

A group of healthy individuals will serve as a control population.

Expected total enrollment 20 patients in each group, and 10 healthy controls.

Patient data collection

For each patient, the following data will be collected:

  • Demographic data: age, sex, height, weight, ICU admission date, simplified acute physiology score II (SAPS II), injury severity score (ISS), abbreviated injury scale (AIS) at ICU admission.
  • Trauma-related data: number and type of trauma-related organ injuries, initial GCS, presence of mydriasis at initial management.
  • Factors with potential impact on microbiota: antimicrobial therapy, nutrition type, medications (proton pump inhibitors, opioids, sedations, catecholamines, steroids), surgical procedure during ICU stay.
  • Evolution: multidrug resistant bacteria acquisition during ICU stay, ICU acquired-infections. Mechanical ventilation duration, extrarenal epuration, ICU length of stay, neurological outcome evaluated by disability rating scale (DRS-F) at ICU discharge and at 90 days post trauma, death at ICU discharge and 90 days.

Sample collection

Oropharyngeal and rectal swabs will be performed for each patient within the first 24 hours after ICU admission (day 0), then 48 hours (day 2) and 7 days (day 7) after ICU admission and weekly thereafter until ICU discharge. Rectal and oropharyngeal swabs will be performed by trained paramedical staff using sterile swabs with transport medium ESwab® (Becton, Dickinson and Company, New Jersey, USA). Swabs will be stored at -80°C until DNA extraction.

DNA extraction

DNA extraction will be performed using QIAamp PowerFecal Pro DNA® kit (Qiagen®, Courtaboeuf, France) for rectal swabs and Extracta DNA Prep® kit (Quanta Biosciences®, Beverly, USA) for oropharyngeal swabs. DNA will be quantified by Quantit® dsDNA HighSensitivity Assay Kit (Fisher Scientific).

16S rRNA amplification and sequencing

V3 and V4 regions of bacterial 16S rRNA gene sequences will be amplified by polymerase chain reaction (PCR) with universal primers (TCGTCGGCAGCGTCAGATGTGTATAAGAGACAGCCTACGGGNGGCWGCAG and GTCTCGTGGGCTCGGAGATGTGTATAAGAGACAGGACTACHVGGGTATCTAATCC), following the Illumina MiSeq® System protocol (Illumina®). Amplicons will be purified and then sequenced using MiSeq® sequencing system ((Illumina®).

Sequences processing

Sequences processing and operational taxonomic unit (OTU) clustering will be performed using SHAMAN software (SHiny Application for Metagenomic ANalysis) based on R® software (package DESeq2), provided by Pasteur Institute. Taxonomic classification will be performed using SILVA database reference.

Statistical analysis

Statistical analysis will be performed using SHAMAN software (SHiny Application for Metagenomic ANalysis). Bacterial phyla, families and genera repartition will be analyzed, and relative abundance of bacterial genera will be compared between the different populations. Alpha-diversity will be analyzed using different parameters (Shannon index, Simpson's diversity index), as well as beta-diversity (principal component analysis).

The different populations of patients and healthy volunteers will be compared, and the evolution of microbiota along time will be studied.

Study Type Observational
Study Design Observational Model: Case-Control
Time Perspective: Prospective
Target Follow-Up Duration Not Provided
Biospecimen Retention:   Samples With DNA
Description:

Biospecimen types :

  • Oropharyngeal swabs
  • Rectal swabs

The swabs will be performed for each patient within the first 24 hours after ICU admission (day 0), then 48 hours (day 2) and 7 days (day 7) after ICU admission and weekly thereafter until ICU discharge. Rectal and oropharyngeal swabs will be performed by trained paramedical staff using sterile swabs with transport medium ESwab® (Becton, Dickinson and Company, New Jersey, USA). Swabs will be stored at -80°C until bacterial DNA extraction.

Sampling Method Non-Probability Sample
Study Population Patients who are 18 years of age or older, admitted to intensive care unit for severe trauma.
Condition
  • Traumatic Brain Injury
  • Multiple Trauma
Intervention
  • Procedure: Oropharyngeal swab
    Will be performed by trained paramedical staff using sterile swabs with transport medium ESwab® (Becton, Dickinson and Company, New Jersey, USA). Swabs will be stored at -80°C until DNA extraction.
  • Procedure: Rectal swab
    Will be performed by trained paramedical staff using sterile swabs with transport medium ESwab® (Becton, Dickinson and Company, New Jersey, USA). Swabs will be stored at -80°C until DNA extraction.
  • Procedure: Disability rating scale (DRS-F)
    Will be assessed at day 90 +/- 7 days.
Study Groups/Cohorts
  • Patients with isolated severe traumatic brain injury (TBI)
    TBI with initial Glasgow Coma Scale (GCS) ≤ 8 and AISextrahead score ≤3. Oropharyngeal and rectal swabs will be performed for each patient within the first 24 hours after ICU admission (day 0), then 48 hours (day 2) and 7 days (day 7) after ICU admission and weekly thereafter until ICU discharge.
    Interventions:
    • Procedure: Oropharyngeal swab
    • Procedure: Rectal swab
    • Procedure: Disability rating scale (DRS-F)
  • Patients with severe trauma without TBI
    Patients with severe trauma without TBI (AISextrahead score > 3). Oropharyngeal and rectal swabs will be performed for each patient within the first 24 hours after ICU admission (day 0), then 48 hours (day 2) and 7 days (day 7) after ICU admission and weekly thereafter until ICU discharge.
    Interventions:
    • Procedure: Oropharyngeal swab
    • Procedure: Rectal swab
    • Procedure: Disability rating scale (DRS-F)
  • Healthy Controls

    Persons who have not had the conditions being studied or otherwise related conditions or symptoms, as specified in the eligibility requirements.

    Oropharyngeal and rectal swabs will be taken only once, at inclusion, after that the participation of the control individual in the trial will be completed.

    Interventions:
    • Procedure: Oropharyngeal swab
    • Procedure: Rectal swab
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status Recruiting
Estimated Enrollment
 (submitted: May 24, 2019)
50
Original Estimated Enrollment Same as current
Estimated Study Completion Date October 2021
Estimated Primary Completion Date April 2021   (Final data collection date for primary outcome measure)
Eligibility Criteria

Inclusion Criteria:

  • Admission to Bicêtre Hospital Trauma Center for severe trauma with:

either isolated severe traumatic brain injury (TBI): TBI with initial Glasgow Coma Scale (GCS) ≤ 8 and AISextrahead score ≤3; either severe trauma without TBI (AISextrahead score > 3)

  • Estimated ICU length of stay 48 hours or more

Exclusion Criteria:

  • Antimicrobial therapy within the previous 3 months
  • Long-term corticosteroids use
  • Active cancer
  • Institutionalized patient
  • Gastro-intestinal perforation or emergency gastro-intestinal surgery following trauma
  • Withdrawal of consent
  • Patient under guardianship
  • Pregnant or breastfeeding women
Sex/Gender
Sexes Eligible for Study: All
Ages 18 Years and older   (Adult, Older Adult)
Accepts Healthy Volunteers Yes
Contacts
Contact: Samy Figueiredo, MD, PhD +33 (0)145213441 samy.figueiredo@aphp.fr
Listed Location Countries France
Removed Location Countries  
 
Administrative Information
NCT Number NCT03965611
Other Study ID Numbers APHP180537
2018-A02973-52 ( Other Identifier: IDRCB )
Has Data Monitoring Committee No
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement
Plan to Share IPD: Undecided
Responsible Party Assistance Publique - Hôpitaux de Paris
Study Sponsor Assistance Publique - Hôpitaux de Paris
Collaborators Paris-Saclay University
Investigators
Principal Investigator: Samy Figueiredo, MD, PhD Assistance Publique - Hôpitaux de Paris
PRS Account Assistance Publique - Hôpitaux de Paris
Verification Date February 2021