Abstract
Little is known about the composition and clinical implications of lung microbiome in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia requiring invasive mechanical ventilation and intensive care unit admission. Therefore, this study aimed to explore the longitudinal changes in microbial airway composition and its variations between COPD patients with different weaning outcomes. Fifty-one endotracheal aspirate samples from 21 participants and 5 saline samples were collected as the patient and control group, respectively. Sequence analysis revealed significant increases and upward trends in the relative abundance of the Acinetobacter genus and Acinetobacter baumannii complex species in paired comparisons of sampling points and over time, respectively, in patients with failed weaning (p for trend = 0.012 and 0.012, respectively) but not in those with successful weaning (p for trend = 0.335 and 0.426, respectively). Furthermore, significant changes in the composition of the bacterial community were observed in paired comparisons of sampling points in patients with failed weaning compared with those with successful weaning. The alpha diversity did not differ between the patients with different weaning outcomes. These results further the understanding of longitudinal airway microbiome structure analysis and its clinical implications when managing critically ill patients with and without COPD.
Highlights
Little is known about the composition and clinical implications of lung microbiome in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia requiring invasive mechanical ventilation and intensive care unit admission
A significant increase in the relative abundance of the Acinetobacter genus (p for trend = 0.012) and the A. baumannii complex species (p for trend = 0.012) was observed in patients with failed weaning during the course of the study (Fig. 4a–b). These findings demonstrate that the pattern of changes in the relative abundance of the Acinetobacter genus and the changes in the A. baumannii complex species, were quite divergent between patients with different weaning outcomes
Together with the significant changes in the patterns of relative abundance of the Acinetobacter genus and the A. baumannii complex species in patients with failed weaning compared with successful weaning, these findings suggest that the invasion of this genus and species in the microbial community may be partly responsible for the change in microbiome structure in patients with failed weaning
Summary
Little is known about the composition and clinical implications of lung microbiome in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia requiring invasive mechanical ventilation and intensive care unit admission. 100 90 80 70 60 50 40 30 20 10 0 saline T F S T1 T2 T3 F1 F2 F3 S1 S2 S3 uncultured Bacteroidetes bacterium uncultured bacterium uncultured unclassified Streptococcus Stenotrophomonas Staphylococcus SerraƟa Rothia Rhodanobacter Pseudomonas Proteus Prevotella Neisseria miscellaneous Methanosaeta Listeria Leptotrichia Lactobacillus Klebsiella Haemophilus Granulicatella Fusibacter Escherichia-Shigella Erysipelatoclostridium Enterococcus Elizabethkingia Corynebacterium Citrobacter Chryseobacterium Burkholderia-Caballeronia-Paraburkholderia Bacteroides Alloprevotella AcƟnomyces Acinetobacter Acidovorax Acidocella Achromobacter progression, exacerbation events, administered treatments, and exacerbation phenotypes The findings of these studies show that molecular microbiome technology has made significant advances in understanding the contribution of microbes to the pathogenesis and progression of COPD during both stable and exacerbation states[8,9,10,11,12]. The aims of the current study were to explore the longitudinal profiling of airway microbial composition, and compare the microbial changes over time between patients with COPD and CAP requiring IMV and admission to an ICU who had different weaning outcomes
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