The gut microbiota of intensive care unit (ICU) patients displays extreme dysbiosis associated with increased susceptibility to organ failure, sepsis, and septic shock. However, such dysbiosis is difficult to characterize owing to the high dimensional complexity of the gut microbiota. We tested whether the concept of enterotype can be applied to the gut microbiota of ICU patients to describe the dysbiosis. We collected 131 fecal samples from 64 ICU patients diagnosed with sepsis or septic shock and performed 16S rRNA gene sequencing to dissect their gut microbiota compositions. During the development of sepsis or septic shock and during various medical treatments, the ICU patients always exhibited two dysbiotic microbiota patterns, or ICU-enterotypes, which could not be explained by host properties such as age, sex, and body mass index, or external stressors such as infection site and antibiotic use. ICU-enterotype I (ICU E1) comprised predominantly Bacteroides and an unclassified genus of Enterobacteriaceae, while ICU-enterotype II (ICU E2) comprised predominantly Enterococcus. Among more critically ill patients with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores > 18, septic shock was more likely to occur with ICU E1 (P = 0.041). Additionally, ICU E1 was correlated with high serum lactate levels (P = 0.007). Therefore, different patterns of dysbiosis were correlated with different clinical outcomes, suggesting that ICU-enterotypes should be diagnosed as independent clinical indices. Thus, the microbial-based human index classifier we propose is precise and effective for timely monitoring of ICU-enterotypes of individual patients. This work is a first step toward precision medicine for septic patients based on their gut microbiota profiles.
重症监护病房（ICU）患者肠道菌群的紊乱会增加他们患器官衰竭，脓毒症和感染性休克的几率。然而，由于肠道菌群具有高维复杂性，这种紊乱难以被简单定义。针对这一难题，本文作者应用肠型的概念来将这种ICU菌群紊乱进行分类，并定义为ICU肠型。作者从64位诊断为脓毒症或感染性休克的ICU患者中收集了131份粪便样本，并进行了16S rRNA基因测序，以分析其肠道菌群组成。发现在脓毒症或感染性休克的发展过程中，ICU患者的肠道菌群总是能聚类到两种ICU肠型。并且ICU 肠型的存在并不能由宿主特性如年龄，性别和体重指数，或外部压力因素例如感染部位和抗生素来解释。 ICU肠型I型（ICU E1）主要由拟杆菌属和某肠杆菌科的未鉴定属作为驱动菌，而ICU肠型II型（ICU E2）主要由肠球菌作为驱动菌。在APACHE II得分大于18的危重患者中，ICU E1的患者更有可能发生感染性休克（P = 0.041）。此外，ICU E1的患者会有更高的血清乳酸水平（P = 0.007）。作者发现不同ICU肠型的病人会对应不同的病理状态，可将ICU肠型作为独立的临床指标。作者基于此提出的MHI分类器，对于及时监测单个患者的ICU肠型是精确而有效的。这项研究为基于脓毒症患者肠道菌群的精准医学干预迈出了第一步。





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