Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut.
Clin Infect Dis. 2019 Aug 1;69(4):604-613. doi: 10.1093/cid/ciy936.
Carbapenem-resistant Pseudomonas aeruginosa (CRPA) colonizes the gastrointestinal tract of intensive care unit (ICU) patients, and CRPA colonization puts patients at increased risk of CRPA infection. Prior studies have not examined relationships between the microbiota, medications, and CRPA colonization acquisition.
Data and perirectal swabs were obtained from a cohort of ICU patients at the University of Maryland Medical Center. Patients (N = 109) were classified into 3 groups by CRPA colonization-acquisition status and antimicrobial exposure. We conducted 16S ribosomal RNA gene sequencing of an ICU admission swab and ≥1 additional swab and evaluated associations between patient characteristics, medications, the gastrointestinal microbiota, and CRPA colonization acquisition.
ICU patients had low levels of diversity and high relative abundances of pathobionts. Piperacillin-tazobactam was prescribed more frequently to patients with CRPA colonization acquisition than those without. Piperacillin-tazobactam was associated with low abundance of potentially protective taxa (eg, Lactobacillus and Clostridiales) and increased risk of Enterococcus domination (odds ratio [OR], 5.50; 95% confidence interval [CI], 2.03-14.92). Opioids were associated with dysbiosis in patients who did not receive antibiotics; potentially protective Blautia and Lactobacillus were higher in patients who did not receive opioids. Several correlated taxa, identified at ICU admission, were associated with lower risk of CRPA colonization acquisition (OR, 0.58; 95% CI, .38-.87).
Antibiotics differed in their impact on the microbiota, with piperacillin-tazobactam being particularly damaging. Certain bacterial taxa (eg, Clostridiales) were negatively associated with CRPA colonization acquisition. These taxa may be markers of risk for CRPA colonization acquisition and/or serve a protective role.
耐碳青霉烯铜绿假单胞菌（CRPA）定植于重症监护病房（ICU）患者的胃肠道，且 CRPA 定植使患者 CRPA 感染风险增加。先前的研究并未探究微生物群、药物与 CRPA 定植获得之间的关系。
从马里兰大学医学中心的 ICU 患者队列中获取数据和直肠拭子。根据 CRPA 定植获得状态和抗菌药物暴露情况，将患者（N=109）分为 3 组。我们对 ICU 入院时的拭子和至少 1 个额外拭子进行 16S 核糖体 RNA 基因测序，并评估患者特征、药物、胃肠道微生物群与 CRPA 定植获得之间的关系。
ICU 患者的多样性水平较低，病原菌的相对丰度较高。与无 CRPA 定植获得的患者相比，有 CRPA 定植获得的患者更常被开具哌拉西林他唑巴坦。哌拉西林他唑巴坦与潜在保护性分类群（如乳杆菌属和梭菌目）的低丰度和肠球菌优势（比值比[OR]，5.50；95%置信区间[CI]，2.03-14.92）相关。未接受抗生素治疗的患者中，阿片类药物与肠道菌群失调相关；未接受阿片类药物的患者中，潜在保护性的布劳特氏菌和乳杆菌属含量较高。在 ICU 入院时鉴定的几个相关分类群与 CRPA 定植获得的风险较低相关（OR，0.58；95%CI，0.38-0.87）。
抗生素对微生物群的影响不同，哌拉西林他唑巴坦的破坏性尤其大。某些细菌分类群（如梭菌目）与 CRPA 定植获得呈负相关。这些分类群可能是 CRPA 定植获得的风险标志物，和/或发挥保护作用。
