Temporal airway microbiome changes related to ventilator-associated pneumonia in children.
Temporal airway microbiome changes related to ventilator-associated pneumonia in children.
复制标题
DOI：
10.1183/13993003.01829-2020
复制
发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) members are as follows:
中科院分区：
文献类型：
--
作者：
Mourani PM;Sontag MK;Williamson KM;Harris JK;Reeder R;Locandro C;Carpenter TC;Maddux AB;Ziegler K;Simões EAF;Osborne CM;Ambroggio L;Leroue MK;Robertson CE;Langelier C;DeRisi JL;Kamm J;Hall MW;Zuppa AF;Carcillo J;Meert K;Sapru A;Pollack MM;McQuillen P;Notterman DA;Dean JM;Wagner BD;Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN);Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) members are as follows:
我们试图确定下呼吸道微生物组的时间变化是否与儿童呼吸机相关性肺炎（VAP）相关。使用31天至18岁需要机械通气（MV）支持> 72小时的儿童的多中心前瞻性研究，收集每日气管抽吸物并通过16 S rRNA基因测序进行分析。使用2008年CDC儿科标准评估VAP。采用联合纵向时间-事件模型、配对病例对照比较和无监督聚类分析评价微生物因素与VAP之间的关联。在366例合格受试者中，66例（15%）在插管后中位5天（IQR：3 - 5）发生VAP。插管时，VAP受试者的总细菌载量（TBL）无差异，但VAP受试者的Shannon多样性和链球菌、乳杆菌目和普雷沃菌的相对丰度低于非VAP受试者。然而，较高的TBL在每个连续的日子与较低的风险（HR：0.39; CI：0.23，0.64）发展VAP，但连续值的多样性与VAP无关。从匹配分析和无监督聚类中观察到类似的结果。最常见的优势VAP病原体包括普雷沃菌属（19%）、铜绿假单胞菌（14%）和缓症链球菌/肺炎链球菌（10%）。支原体和脲原体也被确定为几个受试者的优势微生物。在机械通气的儿童中，微生物因素随时间的变化与VAP风险略有相关，尽管这些变化不适合预测个体患者的VAP。这些发现表明，仅关注病原体负荷可能无法充分告知VAP诊断。在机械通气的儿童中，发生VAP和未发生VAP的儿童在插管时的微生物因素略有不同，并且随时间的变化与VAP风险略有相关，这表明其他因素可能导致VAP。
We sought to determine whether temporal changes in the lower airway microbiome are associated with ventilator-associated pneumonia (VAP) in children. Using a multicenter prospective study of children 31 days to 18 years requiring mechanical ventilation (MV) support for > 72 hours, daily tracheal aspirates were collected and analyzed by sequencing of the 16S rRNA gene. VAP was assessed using 2008 CDC pediatric criteria. The association between microbial factors and VAP was evaluated using joint longitudinal time-to-event modeling, matched case-control comparisons, and unsupervised clustering. Of 366 eligible subjects, 66 (15%) developed VAP at a median of 5 (IQR: 3 – 5) days post intubation. At intubation, there was no difference in total bacterial load (TBL), but Shannon diversity and the relative abundance of Streptococcus, Lactobacillales, and Prevotella were lower for VAP subjects versus non-VAP subjects. However, higher TBL on each sequential day was associated with a lower hazard (HR: 0.39; CI: 0.23, 0.64) for developing VAP, but sequential values of diversity were not associated with VAP. Similar findings were observed from the matched analysis and unsupervised clustering. The most common dominant VAP pathogens included Prevotella species (19%), Pseudomonas aeruginosa (14%), and Streptococcus mitis/pneumoniae (10%). Mycoplasma and Ureaplasma were also identified as dominant organisms in several subjects. In mechanically ventilated children, changes over time in microbial factors were marginally associated with VAP risk, although these changes were not suitable for predicting VAP in individual patients. These findings suggest that focusing exclusively on pathogen burden may not adequately inform VAP diagnosis. In mechanically ventilated children, microbial factors were subtly different at intubation between those who did and did not develop VAP, and changes over time were marginally associated with VAP risk, suggesting other factors may contribute to VAP.
登录
查看更多内容
影响因子：
8
作者：
Huffnagle GB;Dickson RP;Lukacs NW
通讯作者：
Lukacs NW
DOI：
10.1152/ajpgi.00098.2010
发表时间：
2010-08-01
影响因子：
4.5
作者：
de La Serre, Claire Barbier;Ellis, Collin L.;Raybould, Helen E.
通讯作者：
Raybould, Helen E.
DOI：
10.1164/ajrccm.155.1.9001306
发表时间：
1997-01-01
影响因子：
24.7
作者：
Fayon, MJ;Tucci, M;Nadeau, D
通讯作者：
Nadeau, D
影响因子：
56.9
作者：
Markle, Janet G. M.;Frank, Daniel N.;Danska, Jayne S.
通讯作者：
Danska, Jayne S.
影响因子：
38.9
作者：
Fischer, JE;Ramser, M;Fanconi, S
通讯作者：
Fanconi, S