Microbial dysbiosis and mortality during mechanical ventilation: a prospective observational study
Autor: | Diane Heels-Ansdell, Louis P. Schenck, Ellen McDonald, Jake C. Szamosi, Dawn M. E. Bowdish, Michael G. Surette, John C. Marshall, Chris P. Verschoor, Jennie Johnstone, Lori Hand, Deborah J. Cook, Daphnée Lamarche, Nicole Zytaruk, Maureen O. Meade, Tim Karachi, Dessi Loukov, Laura Rossi |
---|---|
Jazyk: | angličtina |
Rok vydání: | 2018 |
Předmět: |
0301 basic medicine
Male medicine.medical_specialty Microbial diversity medicine.medical_treatment Pilot Projects Gastrointestinal tract microbiota 03 medical and health sciences 0302 clinical medicine Interquartile range Internal medicine Intensive care medicine Humans Prospective Studies Tissue homeostasis Aged Mechanical ventilation Microbiological Phenomena lcsh:RC705-779 business.industry Incidence (epidemiology) Research Respiratory tract microbiota 030208 emergency & critical care medicine lcsh:Diseases of the respiratory system Middle Aged medicine.disease Respiration Artificial 3. Good health Pneumonia Intensive Care Units 030104 developmental biology medicine.anatomical_structure Biomarker (medicine) Dysbiosis Female Microbiome business Critical illness Respiratory tract |
Zdroj: | Respiratory Research, Vol 19, Iss 1, Pp 1-12 (2018) Respiratory Research |
Popis: | Background Host-associated microbial communities have important roles in tissue homeostasis and overall health. Severe perturbations can occur within these microbial communities during critical illness due to underlying diseases and clinical interventions, potentially influencing patient outcomes. We sought to profile the microbial composition of critically ill mechanically ventilated patients, and to determine whether microbial diversity is associated with illness severity and mortality. Methods We conducted a prospective, observational study of mechanically ventilated critically ill patients with a high incidence of pneumonia in 2 intensive care units (ICUs) in Hamilton, Canada, nested within a randomized trial for the prevention of healthcare-associated infections. The microbial profiles of specimens from 3 anatomical sites (respiratory, and upper and lower gastrointestinal tracts) were characterized using 16S ribosomal RNA gene sequencing. Results We collected 65 specimens from 34 ICU patients enrolled in the trial (29 endotracheal aspirates, 26 gastric aspirates and 10 stool specimens). Specimens were collected at a median time of 3 days (lower respiratory tract and gastric aspirates; interquartile range [IQR] 2–4) and 6 days (stool; IQR 4.25–6.75) following ICU admission. We observed a loss of biogeographical distinction between the lower respiratory tract and gastrointestinal tract microbiota during critical illness. Moreover, microbial diversity in the respiratory tract was inversely correlated with APACHE II score (r = − 0.46, p = 0.013) and was associated with hospital mortality (Median Shannon index: Discharged alive; 1.964 vs. Deceased; 1.348, p = 0.045). Conclusions The composition of the host-associated microbial communities is severely perturbed during critical illness. Reduced microbial diversity reflects high illness severity and is associated with mortality. Microbial diversity may be a biomarker of prognostic value in mechanically ventilated patients. Trial registration ClinicalTrials.gov ID NCT01782755. Registered February 4 2013. Electronic supplementary material The online version of this article (10.1186/s12931-018-0950-5) contains supplementary material, which is available to authorized users. |
Databáze: | OpenAIRE |
Externí odkaz: | |
Nepřihlášeným uživatelům se plný text nezobrazuje | K zobrazení výsledku je třeba se přihlásit. |