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Association between oral microbial dysbiosis and poor functional outcomes in stroke-associated pneumonia patients

Yueran Ren¹, Jingru Liang¹, Xiao Li¹

¹Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.

BMC Microbiology

|October 24, 2023

Abstract

Background:

Despite advances in our understanding of the critical role of the microbiota in stroke patients, the oral microbiome has rarely been reported to be associated with stroke-associated pneumonia (SAP). We sought to profile the oral microbial composition of SAP patients and to determine whether microbiome temporal instability and special taxa are associated with pneumonia progression and functional outcomes.

Methods:

This is a prospective, observational, single-center cohort study that examined patients with acute ischemic stroke (AIS) who were admitted within 24 h of experiencing a stroke event. The patients were divided into three groups based on the occurrence of pneumonia and the use of mechanical ventilation: nonpneumonia group, SAP group, and ventilator-associated pneumonia (VAP) group. We collected oral swabs at different time points post-admission and analyzed the microbiota using 16 S rRNA high-throughput sequencing. The microbiota was then compared among the three groups.

Results:

In total, 104 nonpneumonia, 50 SAP and 10 VAP patients were included in the analysis. We found that SAP and VAP patients exhibited significant dynamic differences in the diversity and composition of the oral microbiota and that the magnitude of this dysbiosis and instability increased during hospitalization. Then, by controlling the potential effect of all latent confounding variables, we assessed the changes associated with pneumonia after stroke and explored patients with a lower abundance of Streptococcus were more likely to suffer from SAP. The logistic regression analysis revealed that an increase in specific taxa in the phylum Actinobacteriota was linked to a higher risk of poor outcomes. A model for SAP patients based on oral microbiota could accurately predict 30-day clinical outcomes after stroke onset.

Conclusions:

We concluded that specific oral microbiota signatures could be used to predict illness development and clinical outcomes in SAP patients. We proposed the potential of the oral microbiota as a non-invasive diagnostic biomarker in the clinical management of SAP patients.

Clinical Trial Registration:

NCT04688138. Registered 29/12/2020, https://clinicaltrials.gov/ct2/show/NCT04688138 .

Insights

The oral microbiome

Area of Science:

Microbiome research
Neurology
Infectious disease

Background:

The oral microbiome's role in stroke-associated pneumonia (SAP) is understudied.
Understanding oral microbial shifts is crucial for managing stroke complications.

Purpose of the Study:

To profile oral microbial composition in SAP patients.
To investigate microbiome temporal instability and specific taxa in relation to pneumonia progression and functional outcomes.

Main Methods:

Prospective, observational, single-center cohort study of acute ischemic stroke (AIS) patients.
Oral swabs analyzed via 16S rRNA sequencing at multiple time points.
Comparison of oral microbiota among nonpneumonia, SAP, and ventilator-associated pneumonia (VAP) groups.

Main Results:

SAP and VAP patients showed significant dynamic oral microbiota differences and increased instability during hospitalization.
Lower abundance of Streptococcus linked to higher SAP risk.
Increased Actinobacteriota taxa associated with poor outcomes.
Oral microbiota model accurately predicted 30-day outcomes in SAP patients.

Conclusions:

Specific oral microbiota signatures can predict SAP development and clinical outcomes.
Oral microbiota shows potential as a non-invasive diagnostic biomarker for SAP management.

Read full analysis

Keywords:

Biomarker Dysbiosis Oral microbiota Prognosis Stroke-associated Pneumonia

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