Intestinal Dysbiosis and Risk of Posttransplant Clostridioides difficile Infection in a Longitudinal Cohort of Liver Transplant Recipients.
Intestinal Dysbiosis and Risk of Posttransplant Clostridioides difficile Infection in a Longitudinal Cohort of Liver Transplant Recipients.
复制标题
肝移植受者纵向队列中的肠道菌群失调和移植后艰难梭菌感染的风险。
作者：
梭状芽胞杆菌感染（CDI）在固体器官移植者中的发病率与其他住院患者更高，并且在肝移植（LT）中常见于肠道微生物组。该患者人群的CDI风险成分尚不完全了解。使用单变量模型的患者和没有CDI的患者进行了16S rRNA测序，在移植和没有CDI的1年内进行了CDI。患有和没有CDI的患者的特定分类群C类肝病，术后胆汁泄漏和使用广谱抗生素的使用与CDI的患者显着相关。有和没有CDI的患者以及在移植后的后期，微生物组成（β多样性）不同还确定了15例（8％）的艰难梭菌定殖患者，他们没有发展CDI，并且可能具有额外的保护因素，临床和微生物组因素可能会融合到CDI风险。可能是微生物组调节恢复高危LT患者微生物多样性的作用。
肝移植（LT）受体的重要性具有较高的梭状芽胞杆菌艰难梭菌感染（CDI），这与较差的结果有关，包括与年级相关的并发症和死亡率，在先前的研究中会增加。 LT患者的艰难梭菌和细菌过度生长的细菌。晚期肝病，手术和其他临床因素是常见的，在移植后期早期，在这项研究中，微生物组变化与CDI风险之间的关系尚不清楚。 CDI在LT之后的第一年内。措施并可能受益于对LT后重建肠道微生物组的新型策略的研究。
Clostridioides difficile infection (CDI) has a higher incidence in solid organ transplant recipients than other hospitalized patients and can lead to poor outcomes. Perturbations to the intestinal microbiome are common in patients undergoing liver transplant (LT); however, the impacts of microbial diversity and composition on risk of CDI in this patient population is incompletely understood. Here, we assessed patients in an established, longitudinal LT cohort for development of CDI within 1 year of transplant. Clinical data were compared for patients with and without CDI using univariable models. 16S rRNA sequencing of fecal samples was performed at multiple pre- and posttransplant time points to compare microbiome α- and β-diversity and enrichment of specific taxa in patients with and without CDI. Of 197 patients who underwent LT, 18 (9.1%) developed CDI within 1 year. Pre-LT Child-Pugh class C liver disease, postoperative biliary leak, and use of broad-spectrum antibiotics were significantly associated with CDI. Patients who developed CDI had significantly lower α-diversity than patients without CDI overall and in samples collected at months 1, 3, and 6. Microbial composition (β-diversity) differed between patients with and without CDI and across sampling time points, particularly later in their posttransplant course. We also identified 15 (8%) patients with toxigenic C. difficile colonization who did not develop CDI and may have had additional protective factors. In summary, clinical and microbiome factors are likely to converge to impart CDI risk. Along with enhanced preventive measures, there may be a role for microbiome modulation to restore microbial diversity in high-risk LT patients. IMPORTANCE Liver transplant (LT) recipients have high rates of Clostridioides difficile infection (CDI), which has been associated with poor outcomes, including graft-related complications and mortality, in prior studies. Susceptibility to CDI is known to increase following perturbations in intestinal commensal bacteria that enable germination of C. difficile spores and bacterial overgrowth. In LT patients, changes in the intestinal microbiome resulting from advanced liver disease, surgery, and other clinical factors is common and most pronounced during the early posttransplant period. However, the relationship between microbiome changes and CDI risk after LT remains unclear. In this study, we investigated clinical and microbiome factors associated with development of CDI within the first year after LT. The importance of this work is to identify patients with high-risk features that should receive enhanced preventive measures and may benefit from the study of novel strategies to reconstitute the intestinal microbiome after LT.
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影响因子：
12.2
作者：
Reeves, Angela E.;Theriot, Casey M.;Young, Vincent B.
通讯作者：
Young, Vincent B.
影响因子：
48
作者：
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通讯作者：
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影响因子：
3.7
作者：
Paudel, Suresh;Zacharioudakis, Ioannis M.;Mylonakis, Eleftherios
通讯作者：
Mylonakis, Eleftherios
影响因子：
11.8
作者：
McDonald, L. Clifford;Gerding, Dale N.;Wilcox, Mark H.
通讯作者：
Wilcox, Mark H.
影响因子：
14.2
作者：
Paltansing, S.;van den Berg, R. J.;Kuijper, E. J.
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Kuijper, E. J.