Reconsidering ventilator-associated pneumonia from a new dimension of the lung microbiome

Fernández-Barat, Laia; López-Aladid, Rubén; Torres, Antoni

doi:10.1016/j.ebiom.2020.102995

Cited by 30 publications

(21 citation statements)

References 75 publications

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“…Similar disruptions in lung homoeostasis have been reported in patients with bacterial ventilator-associated pneumonia (Fernández-Barat et al 2020). Krause et al observed a decrease of fungal diversity in ventilated patient with pneumonia and an increase of Candida spp., representing 75% of fungal species (Krause et al 2016).…”

Section: Discussionsupporting

confidence: 79%

Critically ill patients with COVID-19 show lung fungal dysbiosis with reduced microbial diversity in patients colonized with Candida spp.

Viciani¹,

Gaibani

Castagnetti³

et al. 2022

International Journal of Infectious Diseases

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Objectives The COVID-19 pandemic has intensified interest in how the infection impacts the lung microbiome of critically ill patients and contributes to acute respiratory distress syndrome (ARDS). We aimed to characterize the lower respiratory tract mycobiome of COVID-19 critically ill patients in comparison to COVID-19-negative patients. Methods We performed an Internal transcribed spacer 2 (ITS2) profiling, with the Illumina MiSeq platform, on 26 respiratory specimens from COVID-19 positive patients as well as from 26 patients with non-COVID-19 pneumonia. Results COVID-19+ patients were more likely to be colonized with Candida spp. and ARDS was associated with lung dysbiosis characterised by a shift to Candida species colonisation and a decrease of fungal diversity. We also observed higher bacterial phylogenetic distance among taxa in COVID-19+ colonized patients. In COVID-19+ patients non-colonized with Candida spp , ITS2 amplicon sequencing revealed an increase of Ascomycota unassigned spp. and one Aspergillus spp positive specimen. Then, we found that corticosteroid therapy was frequently associated with positive Galactomannan cell wall component of Aspergillus spp among COVID-19+ patients. Conclusions Our study underpins that ARDS in COVID-19+ patients is associated with lung dysbiosis and that an increased density of Ascomycota unassigned spp. is present in patients not colonized with Candida spp .

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Section: Discussionsupporting

confidence: 79%

Critically ill patients with COVID-19 show lung fungal dysbiosis with reduced microbial diversity in patients colonized with Candida spp.

Viciani¹,

Gaibani

Castagnetti³

et al. 2022

International Journal of Infectious Diseases

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“…Of note, the disruption of microbial homeostasis might be associated with the occurrence of VAP. Indeed, orotracheal intubation, which might impair the natural lung defense mechanisms, is a promoter of microbiome dysbiosis [53]. Furthermore, the gut-lung-microbiome axis is one of current researching hotspots in basic research in recent years.…”

Section: Discussionmentioning

confidence: 99%

Probiotic In The Prevention of Ventilator-Associated Pneumonia In Critically Ill Patients- Evidence From Meta-Analysis And Trial Sequential Analysis of Randomized Clinical Trials

Sun

Wang

et al. 2021

Preprint

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Introduction: Probiotic may have a role in prevention of ventilator-associated pneumonia (VAP) among mechanically ventilated patients, but the efficacy and safety remains inconsistent. The aim of this systematic review and meta-analysis was to evaluate the efficacy and safety of probiotic (prebiotic, synbiotic) versus placebo in preventing VAP in critically ill patients undergoing mechanical ventilation. Methods: PubMed, Embase and the Cochrane library databases were searched to 10 October 2021 without language restriction for randomized or semi-randomized controlled trials evaluating probiotic (prebiotic, synbiotic) vs. placebo in prevention of VAP in critically ill mechanically ventilated patients. The pooled relative risk (RR) along with 95% confidence intervals (CI) were combined using a random-effects model. Furthermore, the trial sequential analysis (TSA) and subgroup analyses were performed. Statistical significance was regarded as P <0.05. Results: Twenty-three trials involving 5543 patients were eligible for meta-analysis. The combined RR of decreasing the risk of VAP by probiotic was 0.67 (0.56, 0.81) for all eligible studies, 0.69 (n =5136; 95% CI=0.57 to 0.84; P<0.01) for adults studies and 0.55 (n=407; 95%CI=0.31 to 0.99; P=0.046) for neonates/children studies. Additionally, the above-mentioned positive finding was verified by the result of TSA, subgroup analyses and cumulative meta-analysis in adult patients. Ample evidence demonstrated the existence of a 31% decrease in RR of incidence of VAP when prophylactic probiotic therapy was administrated among adult patients. Finally, there were no effects on the ICU/hospital/28-/90-day mortality, bacteremia, CRBSI, diarrhea, ICU-acquired infections, infectious complications, pneumonia, UTI and wound infection between two groups (P＞0.05 for all). Conclusion: Based on the results of our study, the current evidences suggested that prophylactic administration of probiotic might be utilized as a preventive method for VAP in neonates/children and adults patients who require mechanical ventilation. However, further large, high-quality RCTs are warranted to assess the efficacy and safety of probiotic treatment in critically ill patients, especially for the neonates/children studies and the long-term consequences of this therapy.

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“…It is anticipated that the results will reshape existing concepts and improve the clinical management of patients accordingly. 82,83 Longitudinal studies of the sputum microbiome in patients with BE 84 suggest that the management of chronic bronchial infection can be improved by therapy for its microbiome. This must consider the burden of the pathogen, the stability of the community, and the acute and chronic responses of the community to antibiotics.…”

Section: Respiratory Microbiome Dysbiosismentioning

confidence: 99%

Pseudomonas aeruginosa in Bronchiectasis

Fernández-Barat

Alcaraz-Serrano

Amaro

et al. 2021

Semin Respir Crit Care Med

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Pseudomonas aeruginosa (PA) in patients with bronchiectasis (BE) is associated with a poor outcome and quality of life, and its presence is considered a marker of disease severity. This opportunistic pathogen is known for its ability to produce biofilms on biotic or abiotic surfaces and to survive environmental stress exerted by antimicrobials, inflammation, and nutrient or oxygen depletion. The presence of PA biofilms has been linked to chronic respiratory infection in cystic fibrosis but not in BE. There is considerable inconsistency in the reported infection/eradication rates of PA and chronic PA. In addition, inadequate antimicrobial treatment may potentiate the progression from intermittent to chronic infection and also the emergence of antibiotic resistance. A better comprehension of the pathophysiology of PA infections and its implications for BE is urgently needed. This can drive improvements in diagnostic accuracy, can move us toward a new consensus definition of chronic infection, can better define the follow-up of patients at risk of PA, and can achieve more successful eradication rates. In addition, the new technological advances regarding molecular diagnostics, -omics, and biomarkers require us to reconsider our traditional concepts.

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Reconsidering ventilator-associated pneumonia from a new dimension of the lung microbiome

Cited by 30 publications

References 75 publications

Critically ill patients with COVID-19 show lung fungal dysbiosis with reduced microbial diversity in patients colonized with Candida spp.

Critically ill patients with COVID-19 show lung fungal dysbiosis with reduced microbial diversity in patients colonized with Candida spp.

Probiotic In The Prevention of Ventilator-Associated Pneumonia In Critically Ill Patients- Evidence From Meta-Analysis And Trial Sequential Analysis of Randomized Clinical Trials

Pseudomonas aeruginosa in Bronchiectasis

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