Cargando…
Microbial dysbiosis and mortality during mechanical ventilation: a prospective observational study
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....
Autores principales: | , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286574/ https://www.ncbi.nlm.nih.gov/pubmed/30526610 http://dx.doi.org/10.1186/s12931-018-0950-5 |
_version_ | 1783379484732293120 |
---|---|
author | Lamarche, Daphnée Johnstone, Jennie Zytaruk, Nicole Clarke, France Hand, Lori Loukov, Dessi Szamosi, Jake C. Rossi, Laura Schenck, Louis P. Verschoor, Chris P. McDonald, Ellen Meade, Maureen O. Marshall, John C. Bowdish, Dawn M. E. Karachi, Tim Heels-Ansdell, Diane Cook, Deborah J. Surette, Michael G. |
author_facet | Lamarche, Daphnée Johnstone, Jennie Zytaruk, Nicole Clarke, France Hand, Lori Loukov, Dessi Szamosi, Jake C. Rossi, Laura Schenck, Louis P. Verschoor, Chris P. McDonald, Ellen Meade, Maureen O. Marshall, John C. Bowdish, Dawn M. E. Karachi, Tim Heels-Ansdell, Diane Cook, Deborah J. Surette, Michael G. |
author_sort | Lamarche, Daphnée |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-6286574 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-62865742018-12-14 Microbial dysbiosis and mortality during mechanical ventilation: a prospective observational study Lamarche, Daphnée Johnstone, Jennie Zytaruk, Nicole Clarke, France Hand, Lori Loukov, Dessi Szamosi, Jake C. Rossi, Laura Schenck, Louis P. Verschoor, Chris P. McDonald, Ellen Meade, Maureen O. Marshall, John C. Bowdish, Dawn M. E. Karachi, Tim Heels-Ansdell, Diane Cook, Deborah J. Surette, Michael G. Respir Res Research 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. BioMed Central 2018-12-07 2018 /pmc/articles/PMC6286574/ /pubmed/30526610 http://dx.doi.org/10.1186/s12931-018-0950-5 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Lamarche, Daphnée Johnstone, Jennie Zytaruk, Nicole Clarke, France Hand, Lori Loukov, Dessi Szamosi, Jake C. Rossi, Laura Schenck, Louis P. Verschoor, Chris P. McDonald, Ellen Meade, Maureen O. Marshall, John C. Bowdish, Dawn M. E. Karachi, Tim Heels-Ansdell, Diane Cook, Deborah J. Surette, Michael G. Microbial dysbiosis and mortality during mechanical ventilation: a prospective observational study |
title | Microbial dysbiosis and mortality during mechanical ventilation: a prospective observational study |
title_full | Microbial dysbiosis and mortality during mechanical ventilation: a prospective observational study |
title_fullStr | Microbial dysbiosis and mortality during mechanical ventilation: a prospective observational study |
title_full_unstemmed | Microbial dysbiosis and mortality during mechanical ventilation: a prospective observational study |
title_short | Microbial dysbiosis and mortality during mechanical ventilation: a prospective observational study |
title_sort | microbial dysbiosis and mortality during mechanical ventilation: a prospective observational study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286574/ https://www.ncbi.nlm.nih.gov/pubmed/30526610 http://dx.doi.org/10.1186/s12931-018-0950-5 |
work_keys_str_mv | AT lamarchedaphnee microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT johnstonejennie microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT zytaruknicole microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT clarkefrance microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT handlori microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT loukovdessi microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT szamosijakec microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT rossilaura microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT schencklouisp microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT verschoorchrisp microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT mcdonaldellen microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT meademaureeno microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT marshalljohnc microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT bowdishdawnme microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT karachitim microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT heelsansdelldiane microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT cookdeborahj microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT surettemichaelg microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy AT microbialdysbiosisandmortalityduringmechanicalventilationaprospectiveobservationalstudy |