PMC9535351_01
(A) Serial changes in the patient's fecal volume. The volume of feces rose to 6,384 mL/day on hospital day 21. TCZ, tocilizumab; mPSL, methylprednisolone; ECMO, extracorporeal membrane oxygenation; MEPM, meropenem; AZM, azithromycin; AMPC/SBT, ampicillin/sulbactam; LVFX, levofloxacin; VCM, vancomycin; NG, nasogastric; MNZ, metronidazole; GCV, ganciclovir. (B) Serial changes in the patient's fluid balance. (C) Serial changes in the patient's hemodynamic and respiratory status. The daily data were taken at 7 am as representative.
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He was intubated and started on ventilatory management and treatment with antivirals, lopinavir and ritonavir (2 tablets two times daily), and antimicrobials, meropenem (MEPM) (3 g/day) and azithromycin (AZM) (500 mg/day) (Fig. 1.).
Fecal Gram stain shows that simplified bacteria cover the field instead of normal bacteria. Upper left: healthy control. Upper right: Enterococcus. Lower left: fungi. Lower right: Klebsiella pneumoniae. The specimens were taken on day 46, day 21, and day 59.
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Fecal Gram stain and culture were performed periodically, and fecal Gram stain showed either the single pattern or the depleted pattern, indicating the loss of diversity in the gut microbiota (Fig. 2).
Serial changes in the proportions of the phyla in the patient's fecal microbiota. Phylum Firmicutes continued to dominate in the feces during the patient's entire intensive care unit stay.
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Fecal metagenomic analysis showed that the phylum Bacteroidetes is predominant in healthy individuals, but the phylum Firmicutes was predominant from admission (Fig. 3).