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Predominance of Lactobacillus spp. Among Patients Who Do Not Acquire Multidrug-Resistant Organisms

  1. Erika M. C. D'Agata5
  1. 1Department of Medicine, Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
  2. 2Department of Integrative Physiology and Pathobiology, Tufts University School of Medicine
  3. 3Department of Medicine, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  4. 4New York University Langone Medical Center, New York
  5. 5Rhode Island Hospital, Brown University, Providence
  1. Correspondence: R. Araos, Clinica Alemana de Santiago, Piso 5, Secretaria de Medicina Interna. Avenue, Vitacura 5951, Santiago, Chile (rafaaraos{at}gmail.com).

Abstract

Background. The emergence and dissemination of multidrug-resistant organisms (MDROs) is a global threat. Characterizing the human microbiome among hospitalized patients and identifying unique microbial signatures among those patients who acquire MDROs may identify novel infection prevention strategies.

Methods. Adult patients admitted to 5 general medical-surgical floors at a 649-bed, tertiary care center in Boston, Massachusetts, were classified according to in-hospital antimicrobial exposure and MDRO colonization status. Within 48 hours of hospital admission (baseline) and at discharge (follow-up), rectal swab samples were obtained, and compared with samples from an external control group of healthy persons from the community. DNA was extracted from samples, next-generation sequencing performed, and microbial community structure and taxonomic features assessed, comparing those who acquired MDROs and those who had not, and the external controls.

Results. Hospitalized patients (n = 44) had reduced microbial diversity and a greater abundance of Escherichia spp. and Enterococcus spp. than healthy controls (n = 26). Among hospitalized patients, 25 had no MDROs at the time of the baseline sample and were also exposed to antimicrobials. Among this group, 7 (28%) acquired ≥1 MDRO; demographic and clinical characteristics were similar between MDRO-acquisition and MDRO-nonacquisition groups. Patients in the nonacquisition group had consistently higher Lactobacillus spp. abundance than those in the acquisition group (linear discriminant score, 3.97; P = .04).

Conclusions. The fecal microbiota of the hospitalized subjects had abnormal community composition, and Lactobacillus spp. was associated with lack of MDRO acquisition, consistent with a protective role.

Key words

  • Received April 13, 2016.
  • Accepted June 17, 2016.
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