Background: Hospital-acquired infections (HAIs) are increasing due to the spread of multi-drug-resistant organisms. Gut dysbiosis in intensive care unit (ICU) patients at admission showed an altered abundance of some bacterial genera associated with the occurrence of HAIs and mortality. In the present study, we investigated the pattern of the gut microbiome in ICU patients at admission to correlate it with the development of HAIs during ICU stay. Methods: Twenty patients admitted to the ICU were included in and a cross-matching control group of 30 healthy subjects of similar age and sex. Stool specimens were collected. Quantitative SYBR green real-time polymerase chain reaction was done for the identification and quantitation of selected bacteria.Results: Out of those twenty patients, 35% developed ventilator associated pneumonia during their ICU stay. Gut microbiome analysis showed a significant decrease in Firmicutes and Firmicutes to Bacteroidetes ratio in ICU patients in comparison to the control and in patients who developed HAIs in comparison to the control group and patients who did not develop HAIs. There was a statistically significant increase in Bacteroides in comparison to the control group. There was a statistically significant decrease in Bifidobacterium and Faecalibacterium prausnitzii and an increase in Lactobacilli in comparison to the control group with a negative correlation between Acute Physiology and Chronic Health Evaluation (APACHE) score and Firmicutes to Bacteroidetes and Prevotella to Bacteroides ratios.Conclusions: Gut dysbiosis of patients at the time of admission highlights the importance of identification of the microbiome of patients admitted at the ICU as a target for preventing of HAIs.

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