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Am J Infect Control. 2016 Jul 1;44(7):830-6. doi: 10.1016/j.ajic.2016.01.003. Epub 2016 Feb 19.

Intestinal microbiome disruption in patients in a long-term acute care hospital: A case for development of microbiome disruption indices to improve infection prevention.

Author information

1
Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Electronic address: ALaufer@cdc.gov.
2
Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
3
Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA.
4
Division of Infectious Diseases, Duke University, Durham, NC.
5
Department of Medicine, Emory University, Atlanta, GA.

Abstract

BACKGROUND:

Composition and diversity of intestinal microbial communities (microbiota) are generally accepted as a risk factor for poor outcomes; however, we cannot yet use this information to prevent adverse outcomes.

METHODS:

Stool was collected from 8 long-term acute care hospital patients experiencing diarrhea and 2 fecal microbiota transplant donors; 16S rDNA V1-V2 hypervariable regions were sequenced. Composition and diversity of each sample were described. Stool was also tested for Clostridium difficile, vancomycin-resistant enterococci (VRE), and carbapenem-resistant Enterobacteriaceae. Associations between microbiota diversity and demographic and clinical characteristics, including antibiotic use, were analyzed.

RESULTS:

Antibiotic exposure and Charlson Comorbidity Index were inversely correlated with diversity (Spearman = -0.7). Two patients were positive for VRE; both had microbiomes dominated by Enterococcus faecium, accounting for 67%-84% of their microbiome.

CONCLUSIONS:

Antibiotic exposure correlated with diversity; however, other environmental and host factors not easily obtainable in a clinical setting are also known to impact the microbiota. Therefore, direct measurement of microbiome disruption by sequencing, rather than reliance on surrogate markers, might be most predictive of adverse outcomes. If and when microbiome characterization becomes a standard diagnostic test, improving our understanding of microbiome dynamics will allow for interpretation of results to improve patient outcomes.

KEYWORDS:

Clostridium difficile; Infection control; antibiotic use; carbapenem-resistant Enterobacteriaceae; intestinal microbiome; long-term acute care; vancomycin-resistant enterococci

PMID:
26905790
PMCID:
PMC6538413
DOI:
10.1016/j.ajic.2016.01.003
[Indexed for MEDLINE]
Free PMC Article

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