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Respiratory Research
Published in: Respiratory Research 1/2018

Open Access 01-12-2018 | Research

Microbial dysbiosis and mortality during mechanical ventilation: a prospective observational study

Authors: Daphnée Lamarche, Jennie Johnstone, Nicole Zytaruk, France Clarke, Lori Hand, Dessi Loukov, Jake C. Szamosi, Laura Rossi, Louis P. Schenck, Chris P. Verschoor, Ellen McDonald, Maureen O. Meade, John C. Marshall, Dawn M. E. Bowdish, Tim Karachi, Diane Heels-Ansdell, Deborah J. Cook, Michael G. Surette, for the PROSPECT Investigators, Canadian Critical Care Trials Group, Canadian Critical Care Translational Biology Group

Published in: Respiratory Research | Issue 1/2018

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Abstract

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.
Appendix
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Metadata
Title
Microbial dysbiosis and mortality during mechanical ventilation: a prospective observational study
Authors
Daphnée Lamarche
Jennie Johnstone
Nicole Zytaruk
France Clarke
Lori Hand
Dessi Loukov
Jake C. Szamosi
Laura Rossi
Louis P. Schenck
Chris P. Verschoor
Ellen McDonald
Maureen O. Meade
John C. Marshall
Dawn M. E. Bowdish
Tim Karachi
Diane Heels-Ansdell
Deborah J. Cook
Michael G. Surette
for the PROSPECT Investigators
Canadian Critical Care Trials Group
Canadian Critical Care Translational Biology Group
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Respiratory Research / Issue 1/2018
Electronic ISSN: 1465-993X
DOI
https://doi.org/10.1186/s12931-018-0950-5

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