Temporal airway microbiome changes related to ventilator-associated pneumonia in children.

TitleTemporal airway microbiome changes related to ventilator-associated pneumonia in children.
Publication TypeJournal Article
Year of Publication2021
AuthorsMourani, PM, Sontag, MK, Williamson, KM, J Harris, K, Reeder, R, Locandro, C, Carpenter, TC, Maddux, AB, Ziegler, K, Simões, EAF, Osborne, CM, Ambroggio, L, Leroue, MK, Robertson, CE, Langelier, C, DeRisi, JL, Kamm, J, Hall, MW, Zuppa, AF, Carcillo, J, Meert, K, Sapru, A, Pollack, MM, McQuillen, P, Notterman, DA, J Dean, M, Wagner, BD
Corporate Authors,
JournalEur Respir J
Volume57
Issue3
Date Published2021 Mar
ISSN1399-3003
Abstract

<p>We sought to determine whether temporal changes in the lower airway microbiome are associated with ventilator-associated pneumonia (VAP) in children.Using a multicentre prospective study of children aged 31 days to 18 years requiring mechanical ventilation support for >72 h, daily tracheal aspirates were collected and analysed by sequencing of the 16S rRNA gene. VAP was assessed using 2008 Centers for Disease Control and Prevention paediatric criteria. The association between microbial factors and VAP was evaluated using joint longitudinal time-to-event modelling, matched case-control comparisons and unsupervised clustering.Out of 366 eligible subjects, 66 (15%) developed VAP at a median of 5 (interquartile range 3-5) days post intubation. At intubation, there was no difference in total bacterial load (TBL), but Shannon diversity and the relative abundance of , Lactobacillales and were lower for VAP subjects non-VAP subjects. However, higher TBL on each sequential day was associated with a lower hazard (hazard ratio 0.39, 95% CI 0.23-0.64) for developing VAP, but sequential values of diversity were not associated with VAP. Similar findings were observed from the matched analysis and unsupervised clustering. The most common dominant VAP pathogens included species (19%), (14%) and / (10%). and were also identified as dominant organisms in several subjects.In mechanically ventilated children, changes over time in microbial factors were marginally associated with VAP risk, although these changes were not suitable for predicting VAP in individual patients. These findings suggest that focusing exclusively on pathogen burden may not adequately inform VAP diagnosis.</p>

DOI10.1183/13993003.01829-2020
Alternate JournalEur Respir J
PubMed ID33008935
PubMed Central IDPMC7979474
Grant ListUG1 HD049983 / HD / NICHD NIH HHS / United States
UG1 HD063108 / HD / NICHD NIH HHS / United States
K23 HL138461 / HL / NHLBI NIH HHS / United States
U01 HD049934 / HD / NICHD NIH HHS / United States
UG1 HD049981 / HD / NICHD NIH HHS / United States
K23 HD096018 / HD / NICHD NIH HHS / United States
UG1 HD050096 / HD / NICHD NIH HHS / United States
UG1 HD083170 / HD / NICHD NIH HHS / United States
UG1 HD083166 / HD / NICHD NIH HHS / United States
R01 HL124103 / HL / NHLBI NIH HHS / United States
UG1 HD083171 / HD / NICHD NIH HHS / United States