Monitoring the Clinical and Immunological Effects of Microbiome Changes Following Severe Burn Injury
NCT ID: NCT07329595
Last Updated: 2026-01-09
Study Results
Results pending
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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Recruitment Status
RECRUITING
Total Enrollment
30 participants
Study Classification
OBSERVATIONAL
Study Start Date
2023-12-01
Study Completion Date
2026-12-31
Brief Summary
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The aim of this study is to longitudinally monitor dynamic changes in the gut microbiome following severe burn injury using fecal samples. Under standard nutritional protocols and intensive care management, serial fecal sampling is performed to assess alterations in microbiome diversity and composition, as well as the indirect effects of these changes on measurable inflammatory biomarkers, endocrine, hematological, immunological, and other organ-specific parameters, the clinical course, and patient outcomes.
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Detailed Description
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Severe burn injury induces stress-related intestinal damage, leading to decreased gut perfusion, cellular injury, increased mucosal permeability, and reduced intestinal motility. These pathophysiological changes facilitate bacterial and endotoxin translocation, making the gut microbiome a major source of endogenous infection. Recent evidence indicates that the gut microbiome plays a critical role in regulating immune responses and supporting post-injury recovery, while also contributing to the development of complications such as sepsis and multi-organ failure.
The aim of this study is to longitudinally monitor dynamic changes in the gut microbiome following severe burn injury using fecal samples. Under standard nutritional protocols and intensive care management, serial fecal sampling is performed to assess alterations in microbiome diversity and composition, as well as the indirect effects of these changes on measurable inflammatory biomarkers, endocrine, hematological, immunological, and other organ-specific parameters, the clinical course, and patient outcomes. Clinical outcomes are evaluated based on mortality, length of hospital stay, duration of mechanical ventilation, incidence of secondary infections, rate of bacteremia, organ failure and its severity (assessed using the SOFA score), and wound healing.
Upon enrollment, patients undergo rectal swab collection and initial fecal sampling, followed by weekly fecal sample collection one to two times per week, alongside weekly laboratory investigations in addition to standard care. For microbiome analysis, DNA is extracted from fecal samples, followed by PCR amplification of the 16S bacterial rRNA operon. The amplified regions are sequenced, and taxa are identified based on sequence data. Relative abundances of taxa are calculated, and alpha- and beta-diversity metrics are compared within serial samples from individual patients and between patients.
The aim of this study is to longitudinally monitor dynamic changes in the gut microbiome following severe burn injury using fecal samples. Under standard nutritional protocols and intensive care management, serial fecal sampling is performed to assess alterations in microbiome diversity and composition, as well as the indirect effects of these changes on measurable inflammatory biomarkers, endocrine, hematological, immunological, and other organ-specific parameters, the clinical course, and patient outcomes. Clinical outcomes are evaluated based on mortality, length of hospital stay, duration of mechanical ventilation, incidence of secondary infections, rate of bacteremia, organ failure and its severity (assessed using the SOFA score), and wound healing.
Upon enrollment, patients undergo rectal swab collection and initial fecal sampling, followed by weekly fecal sample collection one to two times per week, alongside weekly laboratory investigations in addition to standard care. For microbiome analysis, DNA is extracted from fecal samples, followed by PCR amplification of the 16S bacterial rRNA operon. The amplified regions are sequenced, and taxa are identified based on sequence data. Relative abundances of taxa are calculated, and alpha- and beta-diversity metrics are compared within serial samples from individual patients and between patients.
Conditions
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Severely Burned Patients
Gut Microbiota Diversity and Composition
Inflammatory Responses
Study Design
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Observational Model Type
CASE_ONLY
Study Time Perspective
PROSPECTIVE
Eligibility Criteria
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Inclusion Criteria
* Adult patients (age between 18 and 65 years) meeting the diagnostic criteria for severe burn injury, burns involving more than 20% of the total body surface area (TBSA) and/or inhalation injury.
* Burn injury caused by scalding, flame, electrical, contact, or chemical exposure
* Hospital admission within 24 hours following injury
* Burn injury caused by scalding, flame, electrical, contact, or chemical exposure
* Hospital admission within 24 hours following injury
Exclusion Criteria
* Patients with inflammatory bowel diseases or malignant neoplasms.
* Patients with a history of major gastric and/or intestinal resections
* Patients in a pre-injury ECOG performance status of 4.
* Patients with a history of major gastric and/or intestinal resections
* Patients in a pre-injury ECOG performance status of 4.
Minimum Eligible Age
18 Years
Maximum Eligible Age
65 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
No
Sponsors
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Tamas Vegh, MD
OTHER
Sponsor Role
lead
Responsible Party
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Tamas Vegh, MD
MD PhD
Responsibility Role
SPONSOR_INVESTIGATOR
Principal Investigators
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Lenke Jenei Kluch, MD
Role: PRINCIPAL_INVESTIGATOR
University of Debrecen
Locations
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University of Debrecen, Department of Anesthesiology and Intensive Care
Debrecen, Hajdú-Bihar, Hungary
Site Status
RECRUITING
Countries
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Hungary
Central Contacts
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Facility Contacts
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References
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Jeschke MG, van Baar ME, Choudhry MA, Chung KK, Gibran NS, Logsetty S. Burn injury. Nat Rev Dis Primers. 2020 Feb 13;6(1):11. doi: 10.1038/s41572-020-0145-5.
Reference Type
BACKGROUND
Nakajima M, Kojiro M, Aso S, Matsui H, Fushimi K, Kaita Y, Goto H, Yamaguchi Y, Yasunaga H. Effect of high-dose vitamin C therapy on severe burn patients: a nationwide cohort study. Crit Care. 2019 Dec 12;23(1):407. doi: 10.1186/s13054-019-2693-1.
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BACKGROUND
Song MJ, Kim S, Boo D, Park C, Yoo S, Yoon HI, Cho YJ. Comparison of proton pump inhibitors and histamine 2 receptor antagonists for stress ulcer prophylaxis in the intensive care unit. Sci Rep. 2021 Sep 16;11(1):18467. doi: 10.1038/s41598-021-98069-7.
Reference Type
BACKGROUND
Tanaka H, Matsuda T, Miyagantani Y, Yukioka T, Matsuda H, Shimazaki S. Reduction of resuscitation fluid volumes in severely burned patients using ascorbic acid administration: a randomized, prospective study. Arch Surg. 2000 Mar;135(3):326-31. doi: 10.1001/archsurg.135.3.326.
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BACKGROUND
Wischmeyer PE. Nutrition Therapy in Sepsis. Crit Care Clin. 2018 Jan;34(1):107-125. doi: 10.1016/j.ccc.2017.08.008. Epub 2017 Oct 13.
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Wald EL, Badke CM, Hintz LK, Spewak M, Sanchez-Pinto LN. Vitamin therapy in sepsis. Pediatr Res. 2022 Jan;91(2):328-336. doi: 10.1038/s41390-021-01673-6. Epub 2021 Jul 31.
Reference Type
BACKGROUND
Kahn SA, Beers RJ, Lentz CW. Resuscitation after severe burn injury using high-dose ascorbic acid: a retrospective review. J Burn Care Res. 2011 Jan-Feb;32(1):110-7. doi: 10.1097/BCR.0b013e318204b336.
Reference Type
BACKGROUND
Jeschke MG, Gauglitz GG, Kulp GA, Finnerty CC, Williams FN, Kraft R, Suman OE, Mlcak RP, Herndon DN. Long-term persistance of the pathophysiologic response to severe burn injury. PLoS One. 2011;6(7):e21245. doi: 10.1371/journal.pone.0021245. Epub 2011 Jul 18.
Reference Type
BACKGROUND
Wang Y, Shu Z, Zhu W, Zhou L, Song H, Luo G. The Prognostic Value of N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) in Major Burn Patients With Sepsis. J Burn Care Res. 2022 Nov 2;43(6):1351-1357. doi: 10.1093/jbcr/irac037.
Reference Type
BACKGROUND
Moreno R, Rhodes A, Piquilloud L, Hernandez G, Takala J, Gershengorn HB, Tavares M, Coopersmith CM, Myatra SN, Singer M, Rezende E, Prescott HC, Soares M, Timsit JF, de Lange DW, Jung C, De Waele JJ, Martin GS, Summers C, Azoulay E, Fujii T, McLean AS, Vincent JL. The Sequential Organ Failure Assessment (SOFA) Score: has the time come for an update? Crit Care. 2023 Jan 13;27(1):15. doi: 10.1186/s13054-022-04290-9.
Reference Type
BACKGROUND
McClave SA, Patel J, Bhutiani N. Should fecal microbial transplantation be used in the ICU? Curr Opin Crit Care. 2018 Apr;24(2):105-111. doi: 10.1097/MCC.0000000000000489.
Reference Type
BACKGROUND
van Nood E, Vrieze A, Nieuwdorp M, Fuentes S, Zoetendal EG, de Vos WM, Visser CE, Kuijper EJ, Bartelsman JF, Tijssen JG, Speelman P, Dijkgraaf MG, Keller JJ. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013 Jan 31;368(5):407-15. doi: 10.1056/NEJMoa1205037. Epub 2013 Jan 16.
Reference Type
BACKGROUND
Fu Y, Moscoso DI, Porter J, Krishnareddy S, Abrams JA, Seres D, Chong DH, Freedberg DE. Relationship Between Dietary Fiber Intake and Short-Chain Fatty Acid-Producing Bacteria During Critical Illness: A Prospective Cohort Study. JPEN J Parenter Enteral Nutr. 2020 Mar;44(3):463-471. doi: 10.1002/jpen.1682. Epub 2019 Aug 6.
Reference Type
BACKGROUND
Schroeder BO, Birchenough GMH, Stahlman M, Arike L, Johansson MEV, Hansson GC, Backhed F. Bifidobacteria or Fiber Protects against Diet-Induced Microbiota-Mediated Colonic Mucus Deterioration. Cell Host Microbe. 2018 Jan 10;23(1):27-40.e7. doi: 10.1016/j.chom.2017.11.004. Epub 2017 Dec 21.
Reference Type
BACKGROUND
He W, Wang Y, Wang P, Wang F. Intestinal barrier dysfunction in severe burn injury. Burns Trauma. 2019 Jul 26;7:24. doi: 10.1186/s41038-019-0162-3. eCollection 2019.
Reference Type
BACKGROUND
Earley ZM, Akhtar S, Green SJ, Naqib A, Khan O, Cannon AR, Hammer AM, Morris NL, Li X, Eberhardt JM, Gamelli RL, Kennedy RH, Choudhry MA. Burn Injury Alters the Intestinal Microbiome and Increases Gut Permeability and Bacterial Translocation. PLoS One. 2015 Jul 8;10(7):e0129996. doi: 10.1371/journal.pone.0129996. eCollection 2015.
Reference Type
BACKGROUND
Lima KM, Davis RR, Liu SY, Greenhalgh DG, Tran NK. Longitudinal profiling of the burn patient cutaneous and gastrointestinal microbiota: a pilot study. Sci Rep. 2021 May 21;11(1):10667. doi: 10.1038/s41598-021-89822-z.
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BACKGROUND
Pan YY, Fan YF, Li JL, Cui SY, Huang N, Jin GY, Chen C, Zhang C. [Analysis of the dynamic changes in gut microbiota in patients with extremely severe burns by 16S ribosomal RNA high-throughput sequencing technology]. Zhonghua Shao Shang Za Zhi. 2020 Dec 20;36(12):1159-1166. doi: 10.3760/cma.j.cn501120-20200518-00271. Chinese.
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BACKGROUND
Feng Y, Huang Y, Wang Y, Wang P, Song H, Wang F. Antibiotics induced intestinal tight junction barrier dysfunction is associated with microbiota dysbiosis, activated NLRP3 inflammasome and autophagy. PLoS One. 2019 Jun 18;14(6):e0218384. doi: 10.1371/journal.pone.0218384. eCollection 2019.
Reference Type
BACKGROUND
Rousseau AF, Losser MR, Ichai C, Berger MM. ESPEN endorsed recommendations: nutritional therapy in major burns. Clin Nutr. 2013 Aug;32(4):497-502. doi: 10.1016/j.clnu.2013.02.012. Epub 2013 Mar 14.
Reference Type
BACKGROUND
Clark A, Imran J, Madni T, Wolf SE. Nutrition and metabolism in burn patients. Burns Trauma. 2017 Apr 17;5:11. doi: 10.1186/s41038-017-0076-x. eCollection 2017.
Reference Type
BACKGROUND
Rice TC, Armocida SM, Kuethe JW, Midura EF, Jain A, Hildeman DA, Healy DP, Gulbins E, Caldwell CC. Burn injury influences the T cell homeostasis in a butyrate-acid sphingomyelinase dependent manner. Cell Immunol. 2017 Mar;313:25-31. doi: 10.1016/j.cellimm.2016.12.004. Epub 2016 Dec 26.
Reference Type
BACKGROUND
Feng Y, Huang Y, Wang Y, Wang P, Wang F. Severe burn injury alters intestinal microbiota composition and impairs intestinal barrier in mice. Burns Trauma. 2019 Jul 4;7:20. doi: 10.1186/s41038-019-0156-1. eCollection 2019.
Reference Type
BACKGROUND
Sun M, Wu W, Chen L, Yang W, Huang X, Ma C, Chen F, Xiao Y, Zhao Y, Ma C, Yao S, Carpio VH, Dann SM, Zhao Q, Liu Z, Cong Y. Microbiota-derived short-chain fatty acids promote Th1 cell IL-10 production to maintain intestinal homeostasis. Nat Commun. 2018 Sep 3;9(1):3555. doi: 10.1038/s41467-018-05901-2.
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BACKGROUND
Macfarlane GT, Macfarlane S. Fermentation in the human large intestine: its physiologic consequences and the potential contribution of prebiotics. J Clin Gastroenterol. 2011 Nov;45 Suppl:S120-7. doi: 10.1097/MCG.0b013e31822fecfe.
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BACKGROUND
Korkmaz HI, Flokstra G, Waasdorp M, Pijpe A, Papendorp SG, de Jong E, Rustemeyer T, Gibbs S, van Zuijlen PPM. The Complexity of the Post-Burn Immune Response: An Overview of the Associated Local and Systemic Complications. Cells. 2023 Jan 17;12(3):345. doi: 10.3390/cells12030345.
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Luck ME, Herrnreiter CJ, Choudhry MA. Gut Microbial Changes and their Contribution to Post-Burn Pathology. Shock. 2021 Sep 1;56(3):329-344. doi: 10.1097/SHK.0000000000001736.
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Rae L, Fidler P, Gibran N. The Physiologic Basis of Burn Shock and the Need for Aggressive Fluid Resuscitation. Crit Care Clin. 2016 Oct;32(4):491-505. doi: 10.1016/j.ccc.2016.06.001. Epub 2016 Aug 2.
Reference Type
BACKGROUND
Other Identifiers
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RKEB/IKEB 6649/2023
Identifier Type: REGISTRY
Identifier Source: secondary_id
NNGYK/15506-5/2024
Identifier Type: REGISTRY
Identifier Source: secondary_id
AITT 2023/5
Identifier Type: -
Identifier Source: org_study_id
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