Respiratory Tract Dysbiosis Is Associated with Worse Outcomes in Mechanically Ventilated Patients

• DOI: 10.1164/rccm.201912-2441oc
• Publication Date: 2020-07-27T22:13:18Z
• Authors: Georgios D. Kitsios; Haopu Yang; Libing Yang; Shulin Qin; Adam Fitch; Xiao-Hong Wang; Katherine Fair; John Evankovich; William Bain; Faraaz Shah; Kelvin Li; Barbara Methé; Panayiotis V. Benos; Alison Morris; Bryan J. McVerry
• Keywords: Dysbiosis; Respiratory tract

Rationale: Host inflammatory responses have been strongly associated with adverse outcomes in critically ill patients, but the biologic underpinnings of such heterogeneous not defined.Objectives: We examined whether respiratory tract microbiome profiles are host inflammation and clinical acute failure.Methods: collected oral swabs, endotracheal aspirates (ETAs), plasma samples from mechanically ventilated patients. performed 16S ribosomal RNA gene sequencing to characterize upper lower microbiota classified patients into host-response subphenotypes on basis variables biomarkers innate immunity inflammation. derived diversity metrics composition clusters Dirichlet multinomial models our data for associations outcomes.Measurements Main Results: Oral ETA microbial communities 301 subjects had substantial heterogeneity α β diversity. revealed a cluster low enrichment pathogens (e.g., high Staphylococcus or Pseudomonadaceae relative abundance) 35% samples, hyperinflammatory subphenotype, worse 30-day survival, longer time liberation mechanical ventilation (adjusted P < 0.05), compared higher abundance typical microbiota. Patients evidence dysbiosis (low "protective" oral-origin commensal bacteria) both (17%, combined dysbiosis) significantly survival than without (55%; adjusted 0.05).Conclusions: Respiratory may represent an important, modifiable contributor patient-level systemic outcomes.