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Altered Gut Microbiota as an Auxiliary Diagnostic Indicator for Patients With Fracture-Related Infection
Xingqi Zhao1,2, Wenli Tang3, Haoyang Wan1,2
1Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Abstract:
Preoperative diagnosis of fracture-related infection (FRI) is difficult for patients without obvious signs of infection. However, specific profiles of gut microbiota may be used as a potential diagnostic tool for FRI as suggested by a previous study. The fecal microbiome was compared between 20 FRI patients (FRI group), 18 fracture healed patients (FH group), and 12 healthy controls (HC group) included after collection of fecal samples and evaluation. The α and β diversity indices were used to characterize the fecal microbiome. Dysbiosis indexes were constructed based on the characteristic high-dimensional biomarkers identified in the fecal microbiota from the three groups by linear discriminant analysis and generalized linear model analysis to quantify the dysbiosis of fecal microbiota. The effectiveness of α and β diversity indices and dysbiosis indexes was assessed in distinguishing the fecal microbiome among the three groups. The influences of serum inflammatory factors on gut microbiota were also addressed. The α diversity indices were significantly different between the three groups, the highest in HC group and the lowest in FRI group (P < 0.05). The β diversity indices showed significant phylogenetic dissimilarity of gut microbiome composition among the three groups (P < 0.001). The dysbiosis indexes were significantly higher in FRI group than in FH and HC groups (P < 0.001). The area under Receiver operating characteristic curve showed the characteristics of gut microbiota and the gut microbiota was found as effective in distinguishing the three groups. The dysbiosis in the FRI patients was associated with systemic inflammatory factors. In addition, significant differences in the gut microbiota were not observed between the FRI patients versus without sinus tract or pus before operation. Since FRI patients, with or without sinus tract or pus, have a characteristic profile of gut microbiota, their gut microbiota may be used as an auxiliary diagnostic tool for suspected FRI.
Insights
Specific gut microbiota profiles can help diagnose fracture-related infections (FRI) even without obvious symptoms. This study found distinct fecal microbiome patterns in FRI patients, suggesting its potential as an auxiliary diagnostic tool.
Area of Science:
- Microbiome research
- Infectious disease diagnostics
- Orthopedic surgery
Background:
- Preoperative diagnosis of fracture-related infection (FRI) is challenging, particularly in cases lacking clear clinical signs.
- Previous research suggests that gut microbiota composition may serve as a potential biomarker for FRI.
- Understanding the gut microbiome's role could lead to novel diagnostic approaches for FRI.
Purpose of the Study:
- To compare the fecal microbiome composition across fracture-related infection (FRI) patients, fracture-healed (FH) patients, and healthy controls (HC).
- To assess the diagnostic potential of gut microbiota diversity indices and constructed dysbiosis indexes for FRI.
- To investigate the association between gut microbiota dysbiosis and systemic inflammatory factors in FRI patients.
Main Methods:
- Fecal samples were collected from 20 FRI patients, 18 FH patients, and 12 HC individuals.
- Alpha and beta diversity indices were analyzed to characterize fecal microbiome structure.
- Linear discriminant analysis and generalized linear models were used to identify biomarkers and construct dysbiosis indexes.
Main Results:
- Significant differences in alpha and beta diversity were observed among the three groups, with FRI patients exhibiting the lowest alpha diversity.
- Dysbiosis indexes were significantly elevated in the FRI group compared to FH and HC groups (P < 0.001).
- Receiver operating characteristic curve analysis confirmed the effectiveness of gut microbiota profiles in distinguishing between the groups, irrespective of overt infection signs.
Conclusions:
- Gut microbiota dysbiosis is characteristic of FRI patients and is associated with systemic inflammation.
- Fecal microbiome analysis, including diversity indices and dysbiosis indexes, can effectively differentiate FRI patients from controls.
- Gut microbiota profiles represent a promising auxiliary diagnostic tool for suspected FRI, even in the absence of sinus tract or pus.
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