Late-Onset Bloodstream Infection and Perturbed Maturation of the Gastrointestinal Microbiota in Premature Infants.
Late-Onset Bloodstream Infection and Perturbed Maturation of the Gastrointestinal Microbiota in Premature Infants.
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早产儿迟发性血流感染和胃肠道微生物群成熟紊乱。
DOI：
10.1371/journal.pone.0132923
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Kroll JS
中科院分区：
文献类型：
--
作者：
Shaw AG;Sim K;Randell P;Cox MJ;McClure ZE;Li MS;Donaldson H;Langford PR;Cookson WO;Moffatt MF;Kroll JS
迟发性血流感染(LO-BSI)是早产儿的常见并发症，缺乏及时的诊断和治疗可能会导致危及生命的后果。在诊断早产儿LO-BSI之前，我们试图确定临床特征和胃肠道微生物区系中的微生物特征。从369名早产儿(妊娠32周)收集了两年多的每日粪便样本和临床数据。我们分析了22名发生LO-BSI的新生儿和44名匹配的对照组婴儿的样本。利用从粪便总DNA中扩增出的16S rRNA基因区的下一代测序方法，对诊断前来自Lo-BSI婴儿和对照组的粪便样本的微生物区系进行了分析。对选定的样本进行培养，并用MALDI-TOF鉴定细菌分离物。比较血液和粪便分离株的抗生素图谱，以探索菌株的相似性。从诊断前一周开始，Lo-BSI婴儿的粪便需氧菌/兼性厌氧菌比例高于对照组。通过多因素分析确定LO-BSI的危险因素。肠杆菌科败血症与先天多株、低出生体重和粪便微生物区系明显的肠杆菌科有关。葡萄球菌败血症与金黄色葡萄球菌OTU粪便过多，以及诊断为机械通气前的天数和中央放置管路的存在有关。在12个病例中，血液分离株的抗菌谱与收集的最接近诊断的样本中粪便微生物区系的成分相匹配。胃肠道是LO-BSI生物的重要储存库，病原体通过上皮屏障转运。LO-BSI与异常的微生物区系有关，有大量的葡萄球菌和肠杆菌科细菌，以及不能成熟为优势的专性厌氧菌。
Late-onset bloodstream infection (LO-BSI) is a common complication of prematurity, and lack of timely diagnosis and treatment can have life-threatening consequences. We sought to identify clinical characteristics and microbial signatures in the gastrointestinal microbiota preceding diagnosis of LO-BSI in premature infants. Daily faecal samples and clinical data were collected over two years from 369 premature neonates (<32 weeks gestation). We analysed samples from 22 neonates who developed LO-BSI and 44 matched control infants. Next-generation sequencing of 16S rRNA gene regions amplified by PCR from total faecal DNA was used to characterise the microbiota of faecal samples preceding diagnosis from infants with LO-BSI and controls. Culture of selected samples was undertaken, and bacterial isolates identified using MALDI-TOF. Antibiograms from bloodstream and faecal isolates were compared to explore strain similarity. From the week prior to diagnosis, infants with LO-BSI had higher proportions of faecal aerobes/facultative anaerobes compared to controls. Risk factors for LO-BSI were identified by multivariate analysis. Enterobacteriaceal sepsis was associated with antecedent multiple lines, low birth weight and a faecal microbiota with prominent Enterobacteriaceae. Staphylococcal sepsis was associated with Staphylococcus OTU faecal over-abundance, and the number of days prior to diagnosis of mechanical ventilation and of the presence of centrally-placed lines. In 12 cases, the antibiogram of the bloodstream isolate matched that of a component of the faecal microbiota in the sample collected closest to diagnosis. The gastrointestinal tract is an important reservoir for LO-BSI organisms, pathogens translocating across the epithelial barrier. LO-BSI is associated with an aberrant microbiota, with abundant staphylococci and Enterobacteriaceae and a failure to mature towards predominance of obligate anaerobes.