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Pathogen colonization of the gastrointestinal microbiome at intensive care unit admission and risk for subsequent
Daniel E Freedberg1, Margaret J Zhou2, Margot E Cohen3
1Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, 630 West 168th Street, New York, NY, 10032, USA. def2004@cumc.columbia.edu.
Purpose:
Loss of colonization resistance within the gastrointestinal microbiome facilitates the expansion of pathogens and has been associated with death and infection in select populations. We tested whether gut microbiome features at the time of intensive care unit (ICU) admission predict death or infection.
Methods:
This was a prospective cohort study of medical ICU adults. Rectal surveillance swabs were performed at admission, selectively cultured for vancomycin-resistant Enterococcus (VRE), and assessed using 16S rRNA gene sequencing. Patients were followed for 30 days for death or culture-proven bacterial infection.
Results:
Of 301 patients, 123 (41%) developed culture-proven infections and 76 (25%) died. Fecal biodiversity (Shannon index) did not differ based on death or infection (p = 0.49). The presence of specific pathogens at ICU admission was associated with subsequent infection with the same organism for Escherichia coli, Pseudomonas spp., Klebsiella spp., and Clostridium difficile, and VRE at admission was associated with subsequent Enterococcus infection. In a multivariable model adjusting for severity of illness, VRE colonization and Enterococcus domination (≥ 30% 16S reads) were both associated with death or all-cause infection (aHR 1.46, 95% CI 1.06-2.00 and aHR 1.47, 95% CI 1.00-2.19, respectively); among patients without VRE colonization, Enterococcus domination was associated with excess risk of death or infection (aHR 2.13, 95% CI 1.06-4.29).
Conclusions:
Enterococcus status at ICU admission was associated with risk for death or all-cause infection, and rectal carriage of common ICU pathogens predicted specific infections. The gastrointestinal microbiome may have a role in risk stratification and early diagnosis of ICU infections.
Insights
Gut microbiome analysis at intensive care unit (ICU) admission can predict patient outcomes. Enterococcus presence and domination are linked to increased risk of death or infection in ICU patients.
Area of Science:
- Microbiology
- Infectious Diseases
- Critical Care Medicine
Background:
- The gastrointestinal microbiome plays a crucial role in maintaining colonization resistance against pathogens.
- Disruptions in gut microbiome composition are linked to increased susceptibility to infections and mortality in vulnerable patient populations.
- Understanding microbiome dynamics in intensive care unit (ICU) patients is vital for predicting clinical outcomes.
Purpose of the Study:
- To investigate whether specific gut microbiome features at the time of ICU admission can predict patient mortality or the development of infections.
- To identify microbial markers associated with adverse outcomes in critically ill patients.
Main Methods:
- A prospective cohort study involving adult patients admitted to a medical ICU.
- Rectal surveillance swabs were collected at ICU admission for vancomycin-resistant Enterococcus (VRE) culture and 16S rRNA gene sequencing.
- Patients were monitored for 30 days post-admission to record occurrences of death or culture-proven bacterial infections.
Main Results:
- Of 301 patients, 41% developed infections and 25% died within 30 days.
- Fecal microbial biodiversity (Shannon index) did not significantly differ between patients who died or developed infections.
- The presence of specific pathogens like Escherichia coli, Pseudomonas spp., Klebsiella spp., Clostridium difficile, and VRE at admission predicted subsequent infections with the same organisms.
- Enterococcus domination (≥30% of 16S reads) and VRE colonization were independently associated with increased risk of death or all-cause infection (aHR 1.47 and 1.46, respectively).
- Among patients without VRE colonization, Enterococcus domination significantly increased the risk of death or infection (aHR 2.13).
Conclusions:
- Enterococcus status and gut microbiome composition at ICU admission are associated with the risk of death and infection.
- Rectal carriage of common ICU pathogens at admission can predict subsequent infections.
- The gut microbiome holds potential as a tool for risk stratification and early diagnosis of infections in ICU settings.
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