Lung Microbiota Predict Clinical Outcomes in Critically Ill Patients

Recent studies have revealed that, in critically ill patients, lung microbiota are altered and correlate with alveolar inflammation. The clinical significance of altered lung bacteria in critical illness is unknown. To determine if clinical outcomes of critically ill patients are predicted by featur...

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Vydáno v:American journal of respiratory and critical care medicine Ročník 201; číslo 5; s. 555
Hlavní autoři: Dickson, Robert P, Schultz, Marcus J, van der Poll, Tom, Schouten, Laura R, Falkowski, Nicole R, Luth, Jenna E, Sjoding, Michael W, Brown, Christopher A, Chanderraj, Rishi, Huffnagle, Gary B, Bos, Lieuwe D J
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States 01.03.2020
Témata:
Adult
Aged
Bacterial Load
Bronchoalveolar Lavage Fluid - microbiology
Clostridiales
Cohort Studies
Critical Illness
Enterobacteriaceae
Female
Gastrointestinal Microbiome
Humans
Lung - microbiology
Male
Microbiota - genetics
Middle Aged
Pasteurellaceae
Principal Component Analysis
Prognosis
Proportional Hazards Models
Respiration, Artificial - statistics & numerical data
Respiratory Distress Syndrome - microbiology
Respiratory Distress Syndrome - therapy
RNA, Ribosomal, 16S - genetics
acute respiratory distress syndrome
lung injury
prognosis
lung microbiome
ISSN:1535-4970, 1535-4970
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Shrnutí:Recent studies have revealed that, in critically ill patients, lung microbiota are altered and correlate with alveolar inflammation. The clinical significance of altered lung bacteria in critical illness is unknown. To determine if clinical outcomes of critically ill patients are predicted by features of the lung microbiome at the time of admission. We performed a prospective, observational cohort study in an ICU at a university hospital. Lung microbiota were quantified and characterized using droplet digital PCR and bacterial 16S ribosomal RNA gene quantification and sequencing. Primary predictors were the bacterial burden, community diversity, and community composition of lung microbiota. The primary outcome was ventilator-free days, determined at 28 days after admission. Lungs of 91 critically ill patients were sampled using miniature BAL within 24 hours of ICU admission. Patients with increased lung bacterial burden had fewer ventilator-free days (hazard ratio, 0.43; 95% confidence interval, 0.21-0.88), which remained significant when the analysis was controlled for pneumonia and severity of illness. The community composition of lung bacteria predicted ventilator-free days (  = 0.003), driven by the presence of gut-associated bacteria (e.g., species of the Lachnospiraceae and Enterobacteriaceae families). Detection of gut-associated bacteria was also associated with the presence of acute respiratory distress syndrome. Key features of the lung microbiome (bacterial burden and enrichment with gut-associated bacteria) predict outcomes in critically ill patients. The lung microbiome is an understudied source of clinical variation in critical illness and represents a novel therapeutic target for the prevention and treatment of acute respiratory failure.
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ISSN:1535-4970
1535-4970
DOI:10.1164/rccm.201907-1487OC