Association of nasopharyngeal microbiota profiles with bronchiolitis severity in infants hospitalised for bronchiolitis.
Association of nasopharyngeal microbiota profiles with bronchiolitis severity in infants hospitalised for bronchiolitis.
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DOI：
10.1183/13993003.00152-2016
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发表时间：
2016-11
期刊：
影响因子：
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通讯作者：
the MARC-35 Investigators
中科院分区：
文献类型：
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作者：
Hasegawa K;Mansbach JM;Ajami NJ;Espinola JA;Henke DM;Petrosino JF;Piedra PA;Shaw CA;Sullivan AF;Camargo CA Jr;the MARC-35 Investigators
关于气道微生物群的具体组成与细支气管炎严重程度之间的关系知之甚少。我们的目的是确定鼻咽部微生物群特征，并将这些特征与因细支气管炎住院的婴儿的急性严重程度联系起来。我们对 2011 年至 2014 年三个冬天因细支气管炎住院的 1005 名婴儿（年龄 <1 岁）进行了一项多中心前瞻性队列研究。通过对住院 24 小时内收集的鼻咽抽吸物应用 16S rRNA 基因序列和聚类方法，我们确定了鼻咽微生物群特征及其与细支气管炎严重程度的关联。主要结局是重症监护的使用——即入住重症监护病房或使用机械通气。我们确定了四种不同的鼻咽微生物群特征——三种特征以嗜血杆菌、莫拉氏菌或链球菌为主，而第四种特征具有最高的细菌丰富度。嗜血杆菌为主的婴儿的重症监护使用率最高，而莫拉氏菌为主的婴儿的重症监护使用率最低（20.2% vs 12.3%；未经调整的 OR，1.81；95%CI，1.07-3.11；P=0.03）。调整 11 项患者层面的混杂因素后，嗜血杆菌为主的婴儿的发病率仍然显着较高（OR，1.98；95% CI，1.08-3.62；P=0.03）。这些发现在 307 名因细支气管炎住院儿童组成的单独队列中得到了外部验证。
Little is known about the relationship between specific composition of the airway microbiota and severity of bronchiolitis. We aimed to identify nasopharyngeal microbiota profiles and to link these profiles to acute severity in infants hospitalized for bronchiolitis. We conducted a multicenter prospective cohort study of 1005 infants (age <1 year) hospitalized for bronchiolitis over three winters, 2011-2014. By applying a 16S rRNA gene sequence and clustering approach to the nasopharyngeal aspirates collected within 24 hours of hospitalization, we determined nasopharyngeal microbiota profiles and their association with bronchiolitis severity. The primary outcome was intensive care use – i.e., admission to an intensive care unit or use of mechanical ventilation. We identified four distinct nasopharyngeal microbiota profiles – three profiles were dominated by either Haemophilus, Moraxella, or Streptococcus, while the fourth profile had the highest bacterial richness. The rate of intensive care use was highest in infants with a Haemophilus-dominant profile and lowest in those with a Moraxella-dominant profile (20.2% vs 12.3%; unadjusted OR, 1.81; 95%CI, 1.07-3.11; P=0.03). After adjusting for 11 patient-level confounders, the rate remained significantly higher in infants with a Haemophilus-dominant profile (OR, 1.98; 95%CI, 1.08-3.62; P=0.03). These findings were externally validated in a separate cohort of 307 children hospitalized for bronchiolitis.