Protective Factors in the Intestinal Microbiome Against Clostridium difficile Infection in Recipients of Allogeneic Hematopoietic Stem Cell Transplantation
Protective Factors in the Intestinal Microbiome Against Clostridium difficile Infection in Recipients of Allogeneic Hematopoietic Stem Cell Transplantation
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DOI：
10.1093/infdis/jix011
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发表时间：
2017-04-01
影响因子：
6.4
通讯作者：
Taur, Ying
中科院分区：
文献类型：
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作者：
Lee, Yeon Joo;Arguello, Esther S.;Taur, Ying
背景艰难梭菌感染（CDI）是异基因造血干细胞移植（allo-HSCT）接受者的常见并发症，接受强化治疗可显著破坏肠道微生物群。在这项研究中，我们检查了异基因造血干细胞移植受体的微生物群组成，以确定细菌定植，赋予保护免受CDI移植后。对移植时从成人受体allo-HSCT收集的粪便进行分析;对每个样本的16 S核糖体RNA基因进行测序和分析。通过线性判别分析、效应量分析鉴定出对CDI发展具有保护作用的细菌类群，然后使用生存分析进一步评估CDI的临床预测因子。共研究了234例allo-HSCT受者; 53例（22.6%）发生了移植后CDI。在微生物群的组成中，3种不同细菌分类群的存在与针对CDI的保护相关：拟杆菌属、毛螺菌科和瘤胃球菌科。在植入时这些组的定植与CDI的风险降低60%相关，与临床因素无关。这3个细菌群的定植与较低的CDI风险相关。这些群体已被证明是肠道微生物群的重要组成部分。有针对性的努力，以保持他们可能有助于最大限度地减少CDI的风险，在这个高危人群。
Background. Clostridium difficile infection (CDI) is a frequent complication in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT), who receive intensive treatments that significantly disrupt the intestinal microbiota. In this study, we examined the microbiota composition of allo-HSCT recipients to identify bacterial colonizers that confer protection against CDI after engraftment.Methods. Feces collected from adult recipients allo-HSCT at engraftment were analyzed; 16S ribosomal RNA genes were sequenced and analyzed from each sample. Bacterial taxa with protective effects against development of CDI were identified by means of linear discriminant analysis effect size analysis and then further assessed with clinical predictors of CDI using survival analysis.Results. A total of 234 allo-HSCT recipients were studied; postengraftment CDI developed in 53 (22.6%). Within the composition of the microbiota, the presence of 3 distinct bacterial taxa was correlated with protection against CDI: Bacteroidetes, Lachnospiraceae, and Ruminococcaceae. Colonization with these groups at engraftment was associated with a 60% lower risk of CDI, independent of clinical factors.Conclusions. Colonization with these 3 bacterial groups is associated with a lower risk of CDI. These groups have been shown to be vital components of the intestinal microbiota. Targeted efforts to maintain them may help minimize the risk of CDI in this at-risk population.