Felix C F Schmitt1, Anna Lipinski2, Stefan Hofer3, Florian Uhle2, Christian Nusshag4, Thilo Hackert5, Alexander H Dalpke6, Markus A Weigand2, Thorsten Brenner2, Sébastien Boutin7. 1. Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: Felix.Schmitt@med.uni-heidelberg.de. 2. Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany. 3. Department of Anaesthesiology, Kaiserslautern Westpfalz Hospital, Kaiserslautern, Germany. 4. Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany. 5. Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany. 6. Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center For Lung Research (DZL), Heidelberg, Germany; Institute of Medical Microbiology and Hygiene, Technical University Dresden, Dresden, Germany. 7. Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center For Lung Research (DZL), Heidelberg, Germany.
Abstract
BACKGROUND: Patients with sepsis-induced Acute Respiratory Distress Syndrome (ARDS) are hallmarked by high mortality rates. Early, targeted antibiotic therapy is crucial for patients' survival. The clinical use of a Next Generation Sequencing (NGS)-based approach for pathogen identification may lead to an improved diagnostic performance. Therefore, the objective of this study was to examine changes in the pulmonary-microbiome and resulting influences on patients' outcome in septic ARDS, but also to compare NGS- and culture-based diagnostic methods for pathogen identification. METHODS: In total, 30 patients in two groups were enrolled in the study: (1) 15 septic ARDS patients following major abdominal surgery and (2) 15 patients undergoing oesophageal resection serving as controls. In the ARDS group, blood samples were collected at ARDS onset as well as 5 days and 10 days afterwards. At the same timepoints, bronchoalveolar lavages (BAL) were performed to collect epithelial lining fluid for culture-, as well as NGS-based analyses and to evaluate longitudinal changes in the pulmonary microbiome. In the control group, only one BAL and one blood sample were collected. RESULTS: ARDS patients showed a significantly reduced α-diversity (p=0.007**) and an increased dominance (p=0.012*) in their pulmonary-microbiome. The α-diversity-index correlated with the length of stay in the intensive care unit (p-value=0.015) and the need for mechanical ventilation (p-value=0.009). In 42.9% of all ARDS patients, culture-based results were negative, while NGS findings indicated bacterial colonization. CONCLUSION: Sepsis-induced ARDS is associated with a significant dysbiosis of patients' pulmonary-microbiome, which is closely correlated with the clinical course of the disease. TRIAL REGISTRATION: This prospective, observational pilot study was approved by the Ethics Committee of the Medical Faculty of Heidelberg (trial code no. S-063/2015) and was prospectively registered in the German clinical trials register (DRKS-ID: DRKS00008317 prospectively registered: 28.10.2015). All study patients or their legal representatives signed written informed consent.
BACKGROUND:Patients with sepsis-induced Acute Respiratory Distress Syndrome (ARDS) are hallmarked by high mortality rates. Early, targeted antibiotic therapy is crucial for patients' survival. The clinical use of a Next Generation Sequencing (NGS)-based approach for pathogen identification may lead to an improved diagnostic performance. Therefore, the objective of this study was to examine changes in the pulmonary-microbiome and resulting influences on patients' outcome in septic ARDS, but also to compare NGS- and culture-based diagnostic methods for pathogen identification. METHODS: In total, 30 patients in two groups were enrolled in the study: (1) 15 septic ARDSpatients following major abdominal surgery and (2) 15 patients undergoing oesophageal resection serving as controls. In the ARDS group, blood samples were collected at ARDS onset as well as 5 days and 10 days afterwards. At the same timepoints, bronchoalveolar lavages (BAL) were performed to collect epithelial lining fluid for culture-, as well as NGS-based analyses and to evaluate longitudinal changes in the pulmonary microbiome. In the control group, only one BAL and one blood sample were collected. RESULTS:ARDSpatients showed a significantly reduced α-diversity (p=0.007**) and an increased dominance (p=0.012*) in their pulmonary-microbiome. The α-diversity-index correlated with the length of stay in the intensive care unit (p-value=0.015) and the need for mechanical ventilation (p-value=0.009). In 42.9% of all ARDSpatients, culture-based results were negative, while NGS findings indicated bacterial colonization. CONCLUSION:Sepsis-induced ARDS is associated with a significant dysbiosis of patients' pulmonary-microbiome, which is closely correlated with the clinical course of the disease. TRIAL REGISTRATION: This prospective, observational pilot study was approved by the Ethics Committee of the Medical Faculty of Heidelberg (trial code no. S-063/2015) and was prospectively registered in the German clinical trials register (DRKS-ID: DRKS00008317 prospectively registered: 28.10.2015). All study patients or their legal representatives signed written informed consent.
Authors: Elizabeth W Tindal; Brandon E Armstead; Sean F Monaghan; Daithi S Heffernan; Alfred Ayala Journal: Expert Opin Ther Targets Date: 2021-04-12 Impact factor: 6.902
Authors: Marisa I Metzger; Simon Y Graeber; Mirjam Stahl; Olaf Sommerburg; Marcus A Mall; Alexander H Dalpke; Sébastien Boutin Journal: Front Cell Infect Microbiol Date: 2021-12-06 Impact factor: 5.293
Authors: Felix C F Schmitt; Martin Schneider; William Mathejczyk; Markus A Weigand; Jane C Figueiredo; Christopher I Li; David Shibata; Erin M Siegel; Adetunji T Toriola; Cornelia M Ulrich; Alexis B Ulrich; Sébastien Boutin; Biljana Gigic Journal: Life (Basel) Date: 2021-03-16