Gut Colonization Preceding Mucosal Barrier Injury Bloodstream Infection in Pediatric Hematopoietic Stem Cell Transplantation Recipients
Gut Colonization Preceding Mucosal Barrier Injury Bloodstream Infection in Pediatric Hematopoietic Stem Cell Transplantation Recipients
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DOI：
10.1016/j.bbmt.2019.07.019
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发表时间：
2019-11-01
影响因子：
4.3
通讯作者：
Seed, Patrick C.
中科院分区：
文献类型：
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作者：
Kelly, Matthew S.;Ward, Doyle V.;Seed, Patrick C.
预计胃肠道是造血干细胞移植（HSCT）后大多数血流感染（BSI）的储存库。全基因组测序和比较基因组学有可能提高我们对 HSCT 受者 BSI 之前肠道定植动态的理解。在一项儿童前瞻性队列研究中（年龄 99.99% 遗传相似性）。这些菌株在 7 种大肠杆菌或屎肠球菌 BSI 中仅 4 种在肠道中占据主导地位，中位时间为 17 天（范围为 6 至 21 天）。肠道微生物群中由此产生的 BSI 菌株丰度的增加通常与特定的抗生素暴露有关。在由这些物种引起的 BSI 之前，粪便样本中阴沟肠球菌和粘液粘液菌的含量并不高。检测 β-内酰胺抗生素和万古霉素的抗生素抗性基因可预测 BSI 菌株的表型抗性。在 BSI 发作之前，在儿科 HSCT 受者的肠道微生物群中观察到引起粘膜屏障损伤 BSI 的细菌菌株，并且肠道内这些菌株的丰度变化发生在大多数 BSI 发作之前。然而，为了有效预测 HSCT 受者的 BSI，可能需要频繁采样肠道微生物群和其他生态位采样。 (C) 2019 年美国移植和细胞治疗学会。由爱思唯尔公司出版
The gastrointestinal tract is the predicted reservoir for most bloodstream infections (BSIs) after hematopoietic stem cell transplantation (HSCT). Whole-genome sequencing and comparative genomics have the potential to improve our understanding of the dynamics of gut colonization that precede BSI in HSCT recipients. Within a prospective cohort study of children (age 99.99% genetic similarity). Gut domination by these strains preceded only 4 of 7 E. coli or E. faecium BSIs by a median of 17 days (range, 6 to 21 days). Increasing abundances of the resulting BSI strains in the gut microbiota were frequently associated with specific antibiotic exposures. E. cloacae and R. mucilaginosa were not highly abundant in fecal samples preceding BSIs caused by these species. The detection of antibiotic resistance genes for beta-lactam antibiotics and vancomycin predicted phenotypic resistance in BSI strains. Bacterial strains causing mucosal barrier injury BSI in pediatric HSCT recipients were observed in the gut microbiota before BSI onset, and changes in the abundances of these strains within the gut preceded most BSI episodes. However, frequent sampling of the gut microbiota and sampling of other ecological niches is likely necessary to effectively predict BSI in HSCT recipients. (C) 2019 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.