A recent phase 2 randomized, placebo-controlled trial explored the potential of inulin, a prebiotic fiber, to prevent gut pathogen colonization and infection in patients admitted to the ICU with sepsis. Despite its promising role in preclinical studies, inulin did not significantly alter the gut microbiome or improve clinical outcomes in this high-risk population.
The trial involved ICU patients with sepsis, randomized to receive placebo, 16 g/day, or 32 g/day of inulin. The primary outcome measured changes in short-chain fatty acid (SCFA)-producing bacteria, considered key to gut health and pathogen resistance. Results showed no significant differences in SCFA levels, microbiome diversity, or rates of gut colonization with pathogens such as vancomycin-resistant Enterococcus (VRE) and multidrug-resistant Gram-negative bacteria (MDR-GNB). Clinical outcomes, including infection rates and mortality, were also unaffected.
These findings highlight the challenges of modifying the gut microbiome in critically ill patients, particularly those receiving broad-spectrum antibiotics. While inulin was well-tolerated, its minimal impact suggests that more potent or targeted microbiome-based therapies may be needed in ICU settings.
