The effect of early enteral nutrition combined with anti-infection intervention on gut bacteria translocation-related infections in patients with severe traumatic brain injury

Objective: To investigate the effect of early enteral nutrition combined with anti-infection intervention on gut bacteria translocation-related infections in patients with severe traumatic brain injury (sTBI). Methods: One hundred and two patients with sTBI were randomly divided into two groups: the patients in one group received routine care after their operations (the control group, n=51) and the other group received enteral nutrition support combined with anti-infection strategies from the first day after their operations (the observation group, n=51). Then the patients' infected tissues were collected, and the pathogenic strains were isolated, inoculated, and cultured. The bacterial strains were identified, and the patterns of the infected strains were recorded. The incidence and site of the infections, the proportion of T-lymphocyte subsets changed, the patients' nutrition level changes after the intervention, the concentrations of the serum inflammatory factors, and the complications were compared between the two groups. Results: The infection rate in the observation group was significantly lower than the rate in the control group (P=0.013). For both groups, gram-negative bacilli (48.78%) were the main infection strain, followed by gram-positive cocci (39.02%), and fungi (12.20%). Compared with the data from the first day after the operation, the ratios of CD4+ and CD4+/CD8+ in the two groups increased significantly on the 15th day after treatment (P<0.001), and the ratios in the observation group increased even more (P<0.001; P=0.017). The total protein (TP), albumin (Alb), and transferrin (TRF) serum levels in the observation group significantly increased (all P<0.01) and were significantly higher than the levels in the control group (all P<0.001) after treatment for 15 days. The TNF-alpha and IL-6 serum levels in both groups decreased significantly (P<0.05 or P<0.01) after the treatment for 15 days and even more in the observation group (P<0.001). The incidence of complications in the observation group was significantly lower than it was in the control group (P=0.009), but there was no significant difference in mortality (P=1). Conclusion: The infection rate of patients with sTBI is very high, and the main pathogen is gram-negative bacilli. Early postoperative enteral nutrition support combined with anti-infection therapy can improve the immune function, balance the nutritional status, reduce the inflammatory reaction, lower the risk of complications, and help to improve patient prognosis.