Intestinal microbiome disruption in patients in a long-term acute care hospital: A case for development of microbiome disruption indices to improve infection prevention - 30/06/16
, Tom J.B. de Man, MS a, †, Colleen S. Kraft, MD b, K. Allison Perry, MS a, Austin W. Chan, MD c, Sung Lieu, MD d, Jeffrey Mikell, MD d, Brandi M. Limbago, PhD a, L. Clifford McDonald, MD aHighlights |
• | Antibiotic exposure was inversely correlated with intestinal microbiome diversity. |
• | Diversity was lower in patients who received third- or fourth-generation cephalosporins. |
• | Charlson Comorbidity Index score was inversely correlated with microbiome diversity. |
• | Directly measuring microbiome disruption might be most predictive of adverse events. |
• | Microbiome disruption indices have the potential to improve infection control efforts. |
Abstract |
Background |
Composition and diversity of intestinal microbial communities (microbiota) are generally accepted as a risk factor for poor outcomes; however, we cannot yet use this information to prevent adverse outcomes.
Methods |
Stool was collected from 8 long-term acute care hospital patients experiencing diarrhea and 2 fecal microbiota transplant donors; 16S rDNA V1-V2 hypervariable regions were sequenced. Composition and diversity of each sample were described. Stool was also tested for Clostridium difficile, vancomycin-resistant enterococci (VRE), and carbapenem-resistant Enterobacteriaceae. Associations between microbiota diversity and demographic and clinical characteristics, including antibiotic use, were analyzed.
Results |
Antibiotic exposure and Charlson Comorbidity Index were inversely correlated with diversity (Spearman = -0.7). Two patients were positive for VRE; both had microbiomes dominated by Enterococcus faecium, accounting for 67%-84% of their microbiome.
Conclusions |
Antibiotic exposure correlated with diversity; however, other environmental and host factors not easily obtainable in a clinical setting are also known to impact the microbiota. Therefore, direct measurement of microbiome disruption by sequencing, rather than reliance on surrogate markers, might be most predictive of adverse outcomes. If and when microbiome characterization becomes a standard diagnostic test, improving our understanding of microbiome dynamics will allow for interpretation of results to improve patient outcomes.
Le texte complet de cet article est disponible en PDF.Key Words : Infection control, intestinal microbiome, long-term acute care, Clostridium difficile, carbapenem-resistant Enterobacteriaceae, vancomycin-resistant enterococci, antibiotic use
Plan
| Funding/support: Supported in part by the Center for AIDS Research (grant no. P30 AI050409, awarded to C.S.K.). |
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| Conflicts of interest: None to report. |
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| Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. |
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| Other information: Raw sequences were placed in the National Center for Biotechnology Information (NCBI) Sequence Read Archive under BioProject ID PRJNA271791. |
Vol 44 - N° 7
P. 830-836 - juillet 2016 Retour au numéro
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