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