Enaud Raphaël, Sioniac Pierre, Imbert Sebastien, Janvier Pierre-Laurent, Camino Adrian, Bui Hoang-Nam, Pillet Odile, Orieux Arthur, Boyer Alexandre, Berger Patrick, Gruson Didier, Delhaes Laurence, Prevel Renaud
Université Bordeaux, Center de Recherche Cardio-Thoracique de Bordeaux, INSERM UMR 1045, Bordeaux, France.
Centre Hospitalier Universitaire Bordeaux, Le Centre de Ressources et de Compétences de la Mucoviscidose Pédiatrique, CIC 1401, Bordeaux, France.
Microbiol Spectr. 2023 Mar 28;11(2):e0506222. doi: 10.1128/spectrum.05062-22.
Chronic obstructive pulmonary disease (COPD) affects more than 200 million people worldwide. The chronic course of COPD is frequently worsened by acute exacerbations (AECOPD). Mortality in patients hospitalized for severe AECOPD remains dramatically high, and the underlying mechanisms are poorly understood. Lung microbiota is associated with COPD outcomes in nonsevere AECOPD, but no study specifically investigated severe AECOPD patients. The aim of this study is thus to compare lung microbiota composition between severe AECOPD survivors and nonsurvivors. Induced sputum or endotracheal aspirate was collected at admission from every consecutive severe AECOPD patient. After DNA extraction, the V3-V4 and ITS2 regions were amplified by PCR. Deep-sequencing was performed on a MiSeq sequencer (Illumina); the data were analyzed using DADA2 pipeline. Among 47 patients admitted for severe AECOPD, 25 (53%) with samples of sufficient quality were included: 21 of 25 (84%) survivors and 4 of 25 (16%) nonsurvivors. AECOPD nonsurvivors had lower α-diversities indices than survivors for lung mycobiota but not for lung bacteriobiota. Similar results were demonstrated comparing patients receiving invasive mechanical ventilation ( = 13 [52%]) with those receiving only noninvasive ventilation ( = 12 [48%]). Previous systemic antimicrobial therapy and long-term inhaled corticosteroid therapy could alter the lung microbiota composition in severe AECOPD patients. In acidemic AECOPD, lower lung mycobiota α-diversity is linked to the severity of the exacerbation, assessed by mortality and the requirement for invasive mechanical ventilation, whereas lung bacteriobiota α-diversity is not. This study encourages a multicenter cohort study investigating the role of lung microbiota, especially fungal kingdom, in severe AECOPD. In AECOPD with acidemia, more severe patients-, nonsurvivors and patients requiring invasive mechanical ventilation-have lower lung mycobiota α-diversity than survivors and patients receiving only noninvasive ventilation, respectively. This study encourages a large multicenter cohort study investigating the role of lung microbiota in severe AECOPD and urges investigation of the role of the fungal kingdom in severe AECOPD.
慢性阻塞性肺疾病（COPD）在全球影响着超过2亿人。COPD的慢性病程常因急性加重（AECOPD）而恶化。因严重AECOPD住院患者的死亡率仍然极高，其潜在机制尚不清楚。肺微生物群与非严重AECOPD患者的COPD结局相关，但尚无研究专门调查严重AECOPD患者。因此，本研究的目的是比较严重AECOPD幸存者和非幸存者的肺微生物群组成。从每一位连续入院的严重AECOPD患者入院时收集诱导痰或气管内吸出物。DNA提取后，通过PCR扩增V3-V4和ITS2区域。在MiSeq测序仪（Illumina）上进行深度测序；使用DADA2流程分析数据。在47例因严重AECOPD入院的患者中，纳入了25例（53%）样本质量足够的患者：25例中有21例（84%）幸存者和25例中有4例（16%）非幸存者。AECOPD非幸存者的肺真菌微生物群α多样性指数低于幸存者，但肺细菌微生物群并非如此。比较接受有创机械通气的患者（n = 13 [52%]）和仅接受无创通气的患者（n = 12 [48%]）也得到了类似结果。既往全身抗菌治疗和长期吸入糖皮质激素治疗可能会改变严重AECOPD患者的肺微生物群组成。在酸血症性AECOPD中，较低的肺真菌微生物群α多样性与加重的严重程度相关，加重的严重程度通过死亡率和有创机械通气需求来评估，而肺细菌微生物群α多样性则不然。本研究鼓励开展一项多中心队列研究，以调查肺微生物群，尤其是真菌界，在严重AECOPD中的作用。在酸血症性AECOPD中，病情更严重的患者——非幸存者和需要有创机械通气的患者——其肺真菌微生物群α多样性分别低于幸存者和仅接受无创通气的患者。本研究鼓励开展一项大型多中心队列研究，以调查肺微生物群在严重AECOPD中的作用，并敦促对真菌界在严重AECOPD中的作用进行研究。
