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Gut microbiome features associated with vancomycin-resistant Enterococcus acquisition in intensive care unit patients
Yu-Chung Chuang1, Ronald G Collman2,3, Sheng-Yuan Ruan4
1Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, 100226, Taiwan. weischuang@gmail.com.
Background:
Vancomycin-resistant Enterococcus (VRE) infection poses a significant healthcare burden in intensive care units (ICUs), and is preceded by gut colonization. The gut microbiome may influence susceptibility to VRE, but its role in ICU patients remains incompletely defined.
Methods:
We conducted a prospective study of patients admitted to a medical ICU from 2019 to 2021. Stool samples were collected for bacterial 16 S rRNA gene sequencing, anal swabs were screened for VRE by culture, and bile acids were measured in initial stool samples.
Results:
We enrolled 108 patients. Thirty-four patients were VRE + on initial screen and remained so (VRE+/+) while 74 were initially negative, of whom 23 acquired VRE (VRE-/+) and 51 remained negative (VRE-/-). There was no difference in alpha-diversity initially between VRE-/- and VRE-/+ groups, whereas VRE+/+ patients had significantly lower alpha-diversity (P < 0.001). VRE-/+ patients had a significantly more rapid decrease in alpha-diversity than VRE-/- patients (P = 0.04). Beta-diversity of initial stool differed among groups (P = 0.001), driven mainly by VRE+/+ patients. A lower Bacteroides/Enterococcus ratio (P = 0.049) and low Clostridium scindens abundance (P = 0.031) were associated with VRE acquisition. Initial stool from VRE-/- patients had a higher combined concentration of deoxycholic acid and lithocholic acid than that of VRE-/+ patients (P = 0.034).
Conclusions:
VRE acquisition in the ICU was associated with an initial gut microbiome characterized by lower Bacteroides/Enterococcus ratios, lower C. scindens abundance, and lower deoxycholic and lithocholic acid concentrations. Our findings are consistent with a possible role of these microbiome features in colonization resistance, as suggested by in vitro and animal models. However, given the single-center design, these associations should be considered hypothesis-generating and require validation before clinical application.
Insights
Vancomycin-resistant Enterococcus (VRE) acquisition in ICUs is linked to gut microbiome changes. Lower Bacteroides/Enterococcus ratios and specific bile acids are associated with VRE colonization risk.
Area of Science:
- Microbiology
- Gastroenterology
- Infectious Diseases
Background:
- Vancomycin-resistant Enterococcus (VRE) infections are a major ICU burden.
- Gut colonization precedes VRE infection.
- The gut microbiome's role in VRE susceptibility is not fully understood in ICU settings.
Purpose of the Study:
- To investigate the association between gut microbiome composition and VRE acquisition in ICU patients.
- To identify specific microbial and metabolic markers predictive of VRE colonization.
Main Methods:
- Prospective study of 108 ICU patients.
- 16S rRNA gene sequencing of stool samples.
- VRE screening via anal swabs and bile acid measurement.
Main Results:
- VRE acquisition was linked to lower alpha-diversity and altered beta-diversity.
- Reduced Bacteroides/Enterococcus ratio and low Clostridium scindens abundance correlated with VRE acquisition.
- Lower concentrations of deoxycholic and lithocholic acids were observed in patients acquiring VRE.
Conclusions:
- Gut microbiome features like low Bacteroides/Enterococcus ratio, reduced C. scindens, and specific bile acids may play a role in VRE colonization resistance.
- Findings suggest potential for microbiome-based strategies to prevent VRE.
- Further validation is needed due to the single-center design.
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