Abstract
BackgroundDespite intense interest in the links between the microbiome and human health, little has been written about dysbiosis among ICU patients. We characterized microbial diversity in samples from 37 children in a pediatric ICU (PICU). Standard measures of alpha and beta diversity were calculated, and results were compared with data from adult and pediatric reference datasets.ResultsBacterial 16S rRNA gene sequences were analyzed from 71 total tongue swabs, 50 skin swabs, and 77 stool samples or rectal swabs. The mean age of the PICU patients was 2.9 years (range 1–9 years), and many were chronically ill children that had previously been hospitalized in the PICU. Relative to healthy adults and children, alpha diversity was decreased in PICU GI and tongue but not skin samples. Measures of beta diversity indicated differences in community membership at each body site between PICU, adult, and pediatric groups. Taxonomic alterations in the PICU included enrichment of gut pathogens such as Enterococcus and Staphylococcus at multiple body sites and depletion of commensals such as Faecalibacterium and Ruminococcus from GI samples. Alpha and beta diversity were unstable over time in patients followed longitudinally. We observed the frequent presence of “dominant” pathogens in PICU samples at relative abundance >50%. PICU samples were characterized by loss of site specificity, with individual taxa commonly present simultaneously at three sample sites on a single individual. Some pathogens identified by culture of tracheal aspirates were commonly observed in skin samples from the same patient.ConclusionsWe conclude that the microbiota in critically ill children differs sharply from the microbiota of healthy children and adults. Acknowledgement of dysbiosis associated with critical illness could provide opportunities to modulate the microbiota with precision and thereby improve patient outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s40168-016-0211-0) contains supplementary material, which is available to authorized users.
Highlights
Despite intense interest in the links between the microbiome and human health, little has been written about dysbiosis among ICU patients
A single set of samples was analyzed for 23 subjects, whereas longitudinal series of samples were analyzed for the remaining 14 subjects
We found that the distance between body sites was significantly reduced in pediatric ICU (PICU) patients relative to HMP subjects for all comparisons between sites (Welch’s twosample t test, p values
Summary
Despite intense interest in the links between the microbiome and human health, little has been written about dysbiosis among ICU patients. With the exception of newborn infants, relatively few studies have characterized the microbiota of hospitalized patients [1,2,3,4,5,6,7,8], those that are critically ill. This is an important knowledge gap since dysbiosis may contribute to adverse outcomes among ICU patients and the cost of ICU care [9]. We and others have demonstrated in critically ill adult patients that an ICU stay is associated with appearance of pathogens and loss of commensal
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