Intestinal microbiome disruption in patients in a long-term acute care hospital: A case for development of microbiome disruption indices to improve infection prevention

Abstract

Antibiotic exposure correlated with diversity; however, other environmental and host factors not easily obtainable in a clinical setting are also known to impact the microbiota. Therefore, direct measurement of microbiome disruption by sequencing, rather than reliance on surrogate markers, might be most predictive of adverse outcomes. If and when microbiome characterization becomes a standard diagnostic test, improving our understanding of microbiome dynamics will allow for interpretation of results to improve patient outcomes.

The Human Microbiome and Understanding the 16S rRNA Gene in Translational Nursing Science

“…Antibiotic use also has been implicated in changes in gut microbiota and weight gain, especially in children (Saari, Virta, Sankilampi, Dunkel, & Saxen, 2015; Scott et al, 2016). Antibiotic exposure, bacterial resistance genes and the gut microbiome represent a complex area of research that requires further study (Halpin et al, 2016; Raymond et al, 2016)…”

Can Consideration of the Microbiome Improve Antimicrobial Utilization and Treatment Outcomes in the Oncology Patient?

“…Finally, the abundance of the Bacteroidetes phylum was recently correlated with resistance to the development of immune-mediated colitis in melanoma patients treated with the immune check-point inhibitor, ipilimumab [31]. Thus, these data suggest the importance of developing probability indices which risk-stratify cancer patients with respect to microbiome measurements and other clinical factors, such as antimicrobial administration [32–34]. Predictive risk scores that incorporate microbiome measurements would need to include factors such as diversity metrics, absence of beneficial microbes or microbial by-products (i.e.…”

The Microbiome: Current and Future view of an Ancient Paradigm

“…While it is clear that individuals colonized by multidrug-resistant bacteria are likely to have decreased microbiota diversity [22], allowing organisms that are not typical to dominate the intestinal microbiota, little is known about how this occurs. Research is needed to define the characteristics of an 'ideal' microbiota to be able to identify what should be targeted in a diagnostic test, and ultimately, whether an intervention should occur in order to restore the microbiota.…”

“…Research is needed to define the characteristics of an 'ideal' microbiota to be able to identify what should be targeted in a diagnostic test, and ultimately, whether an intervention should occur in order to restore the microbiota. The concept of a 'microbiome disruption index' has been articulated to guide clinicians away from antibiotics that may markedly disrupt the intestinal microbiome [22], in the same way that cost is used to direct clinicians to provide equally effective but less expensive antibiotics. Overall, definitions of the parameters for normal microbial community structures in patients with various clinical syndromes will be critical to treatment and prevention of disorders associated with alteration of the microbiota.…”