Vidaur Loreto, Guridi Amalur, Leizaola Oihana, Marin Jokin, Rello Jordi, Sarasqueta Cristina, Sorarrain Ane, Marimón Jose María
Intensive Care Unit, Donostia University Hospital, Paseo del Dr. Beguiristain S/N, Donostia-San Sebastián, 20014, Spain.
Biogipuzkoa, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, Microbiology Department, Donostia-San Sebastian, 20014, Spain.
Pneumonia (Nathan). 2025 May 5;17(1):10. doi: 10.1186/s41479-025-00163-1.
To ascertain the role of the lung microbiome in the development of severe pneumonia and its potential as a biomarker for disease progression.
BAL samples from 34 adults with severe community-acquired pneumonia (CAP) (17 viral, 8 viral coinfected with bacteria and 9 bacterial) admitted to the ICU for acute respiratory failure between 2019 and 2021 were collected within the first 48 h of admission to the ICU. The microbiome was characterized via the Ion 16S Metagenomics Kit and the Ion Torrent sequencing platform. Clinical factors, including survival, mechanical ventilation duration, blood biomarkers and organ failure in terms of acute respiratory distress syndrome (ARDS), shock or acute renal failure, were correlated with microbiome characteristics.
The microbiome diversity in patients with viral pneumonia was significantly greater than that in patients with bacterial or coinfected pneumonia: the Shannon diversity index was 3.75 (Q1-Q3: 2.5-4.1) versus 0.4 (Q1-Q3: 0.2-1.3) and 0.48 (Q1-Q3: 0.3-1.1), respectively (p < 0.05). The microbiome diversity index was associated with severity-of-illness (APACHE II), independent of the etiology of pneumonia (B coefficient -1.845; p < 0.01). Patients with severe viral CAP who developed ARDS had a lower presence of Proteobacteria, and those who were complicated with ventilator-associated pneumonia had a higher prevalence of Acinetobacter at admission. The mortality of patients with bacterial or coinfected pneumonia was 35%. In coinfected patients, the diversity index was associated with the development of shock.
Patients with severe CAP have low respiratory microbiome diversity, indicating that respiratory microbiome diversity is a potential biomarker of disease severity.
确定肺部微生物群在重症肺炎发生发展中的作用及其作为疾病进展生物标志物的潜力。
收集了2019年至2021年间因急性呼吸衰竭入住重症监护病房（ICU）的34例成人重症社区获得性肺炎（CAP）患者（17例病毒感染、8例病毒合并细菌感染、9例细菌感染）在入住ICU的头48小时内的支气管肺泡灌洗（BAL）样本。通过Ion 16S宏基因组学试剂盒和Ion Torrent测序平台对微生物群进行表征。将临床因素，包括生存情况、机械通气时间、血液生物标志物以及急性呼吸窘迫综合征（ARDS）、休克或急性肾衰竭方面的器官功能衰竭，与微生物群特征进行关联分析。
病毒性肺炎患者的微生物群多样性显著高于细菌性或合并感染性肺炎患者：香农多样性指数分别为3.75（四分位距：2.5 - 4.1）、0.4（四分位距：0.2 - 1.3）和0.48（四分位距：0.3 - 1.1）（p < 0.05）。微生物群多样性指数与疾病严重程度（急性生理与慢性健康状况评分系统II [APACHE II]）相关，且与肺炎病因无关（B系数 -1.845；p < 0.01）。发生ARDS的重症病毒性CAP患者入院时变形菌门的存在比例较低，而并发呼吸机相关性肺炎的患者入院时不动杆菌的患病率较高。细菌性或合并感染性肺炎患者的死亡率为35%。在合并感染患者中，多样性指数与休克的发生相关。
重症CAP患者的呼吸道微生物群多样性较低，表明呼吸道微生物群多样性是疾病严重程度的潜在生物标志物。
