Temporal airway microbiome changes related to ventilator-associated pneumonia in children

作者：Peter M. Mourani, Marci K. Sontag, Kayla M. Williamson, Jonathan Kirk Harris, Ron Reeder, Chris Locandro, Todd C. Carpenter, Aline B. Maddux, Katherine M. Ziegler, Eric A. F. Simões, Christina M. Osborne, Lilliam Ambroggio, Matthew K. Leroue, Charles E. Robertson, Charles Langelier, Joseph L. DeRisi, Jack Kamm, Mark W. Hall, Athena F. Zuppa, Joseph A. Carcillo, Kathleen L. Meert, Anil Sapru, Murray M. Pollack, Patrick S. McQuillen, Daniel A. Notterman, J. Michael Dean, Brandie D. Wagner · 发表于：European Respiratory Journal · 年份：2020 · DOI：10.1183/13993003.01829-2020 · 被引用次数：34 · 研究领域：Nosocomial Infections in ICU、Gut microbiota and health、Pneumonia and Respiratory Infections

We sought to determine whether temporal changes in the lower airway microbiome are associated with ventilator-associated pneumonia (VAP) in children. Using a multicentre prospective study of children aged 31 days to 18 years requiring mechanical ventilation support for >72 h, daily tracheal aspirates were collected and analysed by sequencing of the 16S rRNA gene. VAP was assessed using 2008 Centers for Disease Control and Prevention paediatric criteria. The association between microbial factors and VAP was evaluated using joint longitudinal time-to-event modelling, matched case–control comparisons and unsupervised clustering. Out of 366 eligible subjects, 66 (15%) developed VAP at a median of 5 (interquartile range 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 (hazard ratio 0.39, 95% 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...