Marin Julie, Ghalayini Mohamed, Kaoudji Younes, Dziri Samira, Zylberfajn Cecile, Blaise Lorraine, Hoogvorst Astrid, Charpentier Stephane, Chaillou Virginie, Beauchamp Sylvie, Donneger Séverine, Barget Nathalie, Touvier Mathilde, Nahon Pierre, Amathieu Roland, Lescat Mathilde
Université Sorbonne Paris Nord and Université Paris Cité, Inserm, IAME, F-93000 Bobigny, France.
Université Sorbonne Paris Nord and Centre hospitalier de Gonesse, Gonesse, France.
J Med Microbiol. 2025 Mar;74(3). doi: 10.1099/jmm.0.001964.
The study of gut microbiota is now an essential dimension in many clinical studies. For instance, microbiota diversity investigation can help us to better manage cirrhotic patients by the identification of markers of severity and the identification of possible sources of pathogens. Conducting clinical research on gut microbiota for fragile patients in intensive care units, such as cirrhotic patients, poses significant challenges. In this study, we developed a comprehensive toolkit for investigating gut microbiota in fragile patients using rectal swabbing combined with straightforward lifestyle and clinical questionnaires. We applied this prospective approach to 49 well-phenotyped cirrhotic patients as a function of their compensation status (compensated patients with outpatients' recruitment vs decompensated patients in intensive care units). Our results, consistent with the literature, showed that liver function impairment is associated with lower microbiota diversity. Additionally, we monitored aerobic microbiota in decompensated cirrhotic patients, observing the invasion of extended spectrum beta-lactamase (ESBL)-producing in the gut's aerobic microbiota prior to severe infection caused by these pathogens. We propose this pragmatic methodology for larger cohort studies, aiming to enhance the monitoring of immunocompromised patients by using microbiota analysis as a predictive tool for the severity of associated pathologies and the identification of agents responsible for severe infections.
肠道微生物群的研究如今已成为许多临床研究的重要方面。例如，微生物群多样性调查有助于我们通过识别严重程度标志物和潜在病原体来源，更好地管理肝硬化患者。对重症监护病房中的脆弱患者（如肝硬化患者）开展肠道微生物群的临床研究面临重大挑战。在本研究中，我们开发了一套综合工具包，通过直肠拭子采集，结合简单的生活方式和临床问卷，来调查脆弱患者的肠道微生物群。我们将这种前瞻性方法应用于49例具有良好表型的肝硬化患者，根据他们的代偿状态（门诊招募的代偿期患者与重症监护病房中的失代偿期患者）进行研究。我们的结果与文献一致，表明肝功能损害与较低的微生物群多样性相关。此外，我们监测了失代偿期肝硬化患者的需氧微生物群，发现在这些病原体引起严重感染之前，产超广谱β-内酰胺酶（ESBL）的细菌已侵入肠道需氧微生物群。我们建议将这种实用方法用于更大规模的队列研究，旨在通过将微生物群分析用作相关疾病严重程度的预测工具以及识别严重感染病原体，加强对免疫功能低下患者的监测。
