Intestinal microbiome disruption in patients in a long-term acute care hospital: a case for development of microbiome disruption indices to improve infection prevention

Details

• Alternative Title:
  Am J Infect Control
• Personal Author:
  Halpin, AL ; de Man, TJ ; Kraft, CS ; Perry, KA ; Chan, AW ; Lieu, S ; Mikell, J ; Limbago, BM ; McDonald, LC
• Description:
  Background
  
  Composition and diversity of intestinal microbial communities (microbiota) are generally accepted as a risk factor for poor outcomes; however, we cannot yet use this information to prevent adverse outcomes.
  
  Methods
  
  Stool was collected from eight long-term acute care hospital (LTACH) patients experiencing diarrhea and two fecal microbiota transplant donors; 16S rDNA V1-V2 hypervariable regions were sequenced. Composition and diversity of each sample were described. Stool was also tested for Clostridium difficile, vancomycin-resistant enterococci (VRE), and carbapenem-resistant Enterobacteriaceae. Associations between microbiota diversity and demographic and clinical characteristics, including antibiotic use, were analyzed.
  
  Results
  
  Antibiotic exposure and Charlson Comorbidity Index were inversely correlated with diversity (Spearman = −0.7). Two patients were positive for VRE; both had microbiomes dominated by Enterococcus faecium, accounting for 67–84% of their microbiome.
  
  Discussion
  
  Antibiotic exposure correlated with diversity; however, other environmental and host factors not easily obtainable in a clinical setting are also known to impact the microbiota. Therefore, direct measurement of microbiome disruption by sequencing, rather than reliance on surrogate markers, might be most predictive of adverse outcomes.
  
  Conclusions
  
  If and when microbiome characterization becomes a standard diagnostic test, improving our understanding of microbiome dynamics will allow for interpretation of results to improve patient outcomes.
• Subjects:
  • Adult
  • Aged
  • Bacteria
  • Cluster Analysis
  • Cross-Sectional Studies
  • DNA, Bacterial
  • DNA, Ribosomal
  • Diarrhea
  • Fecal Microbiota Transplantation
  • Feces
  More +
• Keywords:
  • Chlorination
  • Household water treatment
  • Safe water storage
• Source:
  Am J Infect Control. 44(7):830-836
• Pubmed ID:
  26905790
• Pubmed Central ID:
  PMC6538413
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHSUnited States/ ; P30 AI050409/AI/NIAID NIH HHSUnited States/
• Volume:
  44
• Issue:
  7
• Download URL:
  https://stacks.cdc.gov/view/cdc/79056/cdc_79056_DS1.pdf
• File Type:
  [PDF - 775.16 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:0927240028140a10e3dbb3cd0fdd2ae1c6504a18ead1b41fc3502bb8ac486990