Abstract
Secondary bacterial lung infection (SBLI) is a serious complication in patients with H7N9 virus infection, and increases disease severity. The oropharyngeal (OP) microbiome helps prevent colonisation of respiratory pathogens. We aimed to investigate the OP microbiome of H7N9 patients with/without secondary bacterial pneumonia using 16S rRNA gene sequencing. OP swab samples were collected from 51 H7N9 patients (21 with SBLI and 30 without) and 30 matched healthy controls (HCs) and used for comparative composition, diversity and richness analyses of microbial communities. Principal coordinates analysis successfully distinguished between the OP microbiomes of H7N9 patients and healthy subjects, and the OP microbiome diversity of patients with SBLI was significantly increased. There was significant dysbiosis of the OP microbiome in H7N9 patients, with an abundance of Leptotrichia, Oribacterium, Streptococcus, Atopobium, Eubacterium, Solobacterium and Rothia species in patients with SBLI, and Filifactor, Megasphaera and Leptotrichia species in patients without SBLI, when compared with HCs. Importantly, Haemophilus and Bacteroides species were enriched in HCs. These findings revealed dysbiosis of the OP microbiota in H7N9 patients, and identified OP microbial risk indicators of SBLI, suggesting that the OP microbiome could provide novel and non-invasive diagnostic biomarkers for early microbiota-targeted prophylactic therapies for SBLI prevention.Emerging Microbes & Infections (2017) 6, e112; doi:10.1038/emi.2017.101; published online 20 December 2017
Highlights
During the avian influenza A (H7N9) epidemics of the last 3 years, ~ 150 cases were confirmed in Zhejiang Province, China.[1]
Recent studies have highlighted the clinical significance of influenza-associated bacterial pneumonia, but most have focused directly on the host immune response,[4] and have not examined changes in the human airway microbiota that lead to heightened susceptibility to subsequent pathogenic infections
We aimed to examine the association between dysbiosis of the OP microbiota and avian influenza A (H7N9) virus infection, and assess the susceptibility of these patients to Secondary bacterial lung infection (SBLI) during their hospitalisation
Summary
During the avian influenza A (H7N9) epidemics of the last 3 years, ~ 150 cases were confirmed in Zhejiang Province, China.[1] Similar to the highly pathogenic H5N1 strain, H7N9 causes severe respiratory distress syndrome in most patients. The incidence of secondary bacterial pneumonia, which is mainly caused by multidrug-resistant Acinetobacter baumannii and Klebsiella pneumoniae, is much higher.[3] Secondary bacterial lung infection (SBLI) is a serious complication of influenza infection.[4,5] Current treatment strategies are based on routine culturebased diagnosis methods. Recent studies have highlighted the clinical significance of influenza-associated bacterial pneumonia, but most have focused directly on the host immune response,[4] and have not examined changes in the human airway microbiota that lead to heightened susceptibility to subsequent pathogenic infections
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