Imbert Sébastien, Revers Mathilde, Enaud Raphaël, Orieux Arthur, Camino Adrian, Massri Alexandre, Villeneuve Laurent, Carrié Cédric, Petit Laurent, Boyer Alexandre, Berger Patrick, Gruson Didier, Delhaes Laurence, Prével Renaud
HU Bordeaux, Mycology-Parasitology Department, CIC 1401, 33000, Bordeaux, France.
Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm UMR 1045, Univ Bordeaux, 33000, Bordeaux, France.
Crit Care. 2024 Apr 22;28(1):133. doi: 10.1186/s13054-024-04922-2.
Acute respiratory distress syndrome (ARDS) is responsible for 400,000 deaths annually worldwide. Few improvements have been made despite five decades of research, partially because ARDS is a highly heterogeneous syndrome including various types of aetiologies. Lower airway microbiota is involved in chronic inflammatory diseases and recent data suggest that it could also play a role in ARDS. Nevertheless, whether the lower airway microbiota composition varies between the aetiologies of ARDS remain unknown. The aim of this study is to compare lower airway microbiota composition between ARDS aetiologies, i.e. pulmonary ARDS due to influenza, SARS-CoV-2 or bacterial infection.
Consecutive ARDS patients according to Berlin's classification requiring invasive ventilation with PCR-confirmed influenza or SARS-CoV-2 infections and bacterial infections (> 105 CFU/mL on endotracheal aspirate) were included. Endotracheal aspirate was collected at admission, V3-V4 and ITS2 regions amplified by PCR, deep-sequencing performed on MiSeq sequencer (Illumina®) and data analysed using DADA2 pipeline.
Fifty-three patients were included, 24 COVID-19, 18 influenza, and 11 bacterial CAP-related ARDS. The lower airway bacteriobiota and mycobiota compositions (β-diversity) were dissimilar between the three groups (p = 0.05 and p = 0.01, respectively). The bacterial α-diversity was significantly lower in the bacterial CAP-related ARDS group compared to the COVID-19 ARDS group (p = 0.04). In contrast, influenza-related ARDS patients had higher lung mycobiota α-diversity than the COVID-19-related ARDS (p = 0 < 01).
Composition of lower airway microbiota (both microbiota and mycobiota) differs between influenza, COVID-19 and bacterial CAP-related ARDS. Future studies investigating the role of lung microbiota in ARDS pathophysiology should take aetiology into account.
急性呼吸窘迫综合征（ARDS）每年在全球导致40万人死亡。尽管经过了五十年的研究，进展甚微，部分原因是ARDS是一种高度异质性的综合征，包括各种病因。下呼吸道微生物群与慢性炎症性疾病有关，最近的数据表明它也可能在ARDS中起作用。然而，ARDS不同病因之间下呼吸道微生物群组成是否存在差异仍不清楚。本研究的目的是比较ARDS不同病因之间下呼吸道微生物群组成，即流感、SARS-CoV-2或细菌感染所致的肺部ARDS。
纳入根据柏林分类法连续入选的需要有创通气的ARDS患者，这些患者经PCR确诊为流感或SARS-CoV-2感染以及细菌感染（气管内吸出物中>105 CFU/mL）。入院时收集气管内吸出物，通过PCR扩增V3-V4和ITS2区域，在MiSeq测序仪（Illumina®）上进行深度测序，并使用DADA2流程分析数据。
共纳入53例患者，24例COVID-19相关、18例流感相关和11例细菌性社区获得性肺炎（CAP）相关的ARDS。三组之间下呼吸道细菌群和真菌群组成（β多样性）不同（分别为p = 0.05和p = 0.01）。与COVID-19相关ARDS组相比，细菌性CAP相关ARDS组的细菌α多样性显著更低（p = 0.04）。相反，流感相关ARDS患者的肺部真菌群α多样性高于COVID-19相关ARDS患者（p = 0.001）。
流感、COVID-19和细菌性CAP相关ARDS之间下呼吸道微生物群（细菌群和真菌群）组成不同。未来研究ARDS病理生理学中肺微生物群的作用时应考虑病因。
