Title | Temporal airway microbiome changes related to ventilator-associated pneumonia in children. |
Publication Type | Journal Article |
Year of Publication | 2021 |
Authors | Mourani, 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 | , |
Journal | Eur Respir J |
Volume | 57 |
Issue | 3 |
Date Published | 2021 03 |
ISSN | 1399-3003 |
Keywords | Child, Humans, Intensive Care Units, Microbiota, Pneumonia, Ventilator-Associated, Prospective Studies, RNA, Ribosomal, 16S |
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> |
DOI | 10.1183/13993003.01829-2020 |
Alternate Journal | Eur Respir J |
PubMed ID | 33008935 |
PubMed Central ID | PMC7979474 |
Grant List | UG1 HD049983 / HD / NICHD NIH HHS / United States U10 HD049983 / HD / NICHD NIH HHS / United States UG1 HD063108 / HD / NICHD NIH HHS / United States RL1 HD107773 / 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 |