Alterations in airway microbiota in patients with PAO2/FiO2 ratio < 300 after burn and inhalation injury

Dana M. Walsh, Shaun D. McCullough, Scott Yourstone, Samuel W. Jones, Bruce A. Cairns, Corbin D. Jones, Ilona Jaspers, David Diaz-Sanchez

Research output: Contribution to journalArticle

Abstract

Background Injury to the airways after smoke inhalation is a major mortality risk factor in victims of burn injuries, resulting in a 15±45% increase in patient deaths. Damage to the airways by smoke may induce acute respiratory distress syndrome (ARDS), which is partly characterized by hypoxemia in the airways. While ARDS has been associated with bacterial infection, the impact of hypoxemia on airway microbiota is unknown. Our objective was to identify differences in microbiota within the airways of burn patients who develop hypoxemia early after inhalation injury and those that do not using next-generation sequencing of bacterial 16S rRNA genes. Results DNA was extracted from therapeutic bronchial washings of 48 patients performed within 72 hours of hospitalization for burn and inhalation injury at the North Carolina Jaycee Burn Center. DNA was prepared for sequencing using a novel molecule tagging method and sequenced on the Illumina MiSeq platform. Bacterial species were identified using the MTToolbox pipeline. Patients with hypoxemia, as indicated by a PaO2/FiO2 ratio 300, had a 30% increase in abundance of Streptococcaceae and Enterobacteriaceae and 84% increase in Staphylococcaceae as compared to patients with a PaO2/FiO2 ratio > 300. Wilcoxon rank-sum test identified significant enrichment in abundance of OTUs identified as Prevotella melaninogenica (p = 0.042), Corynebacterium (p = 0.037) and Mogibacterium (p = 0.048). Linear discriminant effect size analysis (LefSe) confirmed significant enrichment of Prevotella melaninognica among patients with a PaO2/FiO2 ratio 300 (p<0.05). These results could not be explained by differences in antibiotic treatment. Conclusions The airway microbiota following burn and inhalation injury is altered in patients with a PaO2/ FiO2 ratio 300 early after injury. Enrichment of specific taxa in patients with a PaO2/FiO2 ratio 300 may indicate airway environment and patient changes that favor these microbes. Longitudinal studies are necessary to identify stably colonizing taxa that play roles in hypoxemia and ARDS pathogenesis.

LanguageEnglish (US)
Article numbere0173848
JournalPLoS ONE
Volume12
Issue number3
DOIs
StatePublished - Mar 1 2017

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Inhalation Burns
Microbiota
breathing
Wounds and Injuries
hypoxia
Adult Respiratory Distress Syndrome
Smoke
smoke
Nonparametric Statistics
Mogibacterium
Staphylococcaceae
Inhalation
Prevotella melaninogenica
Streptococcaceae
burns (injuries)
DNA
Prevotella
Otus
microbiome
Burn Units

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Alterations in airway microbiota in patients with PAO2/FiO2 ratio < 300 after burn and inhalation injury. / Walsh, Dana M.; McCullough, Shaun D.; Yourstone, Scott; Jones, Samuel W.; Cairns, Bruce A.; Jones, Corbin D.; Jaspers, Ilona; Diaz-Sanchez, David.

In: PLoS ONE, Vol. 12, No. 3, e0173848, 01.03.2017.

Research output: Contribution to journalArticle

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abstract = "Background Injury to the airways after smoke inhalation is a major mortality risk factor in victims of burn injuries, resulting in a 15±45\{%} increase in patient deaths. Damage to the airways by smoke may induce acute respiratory distress syndrome (ARDS), which is partly characterized by hypoxemia in the airways. While ARDS has been associated with bacterial infection, the impact of hypoxemia on airway microbiota is unknown. Our objective was to identify differences in microbiota within the airways of burn patients who develop hypoxemia early after inhalation injury and those that do not using next-generation sequencing of bacterial 16S rRNA genes. Results DNA was extracted from therapeutic bronchial washings of 48 patients performed within 72 hours of hospitalization for burn and inhalation injury at the North Carolina Jaycee Burn Center. DNA was prepared for sequencing using a novel molecule tagging method and sequenced on the Illumina MiSeq platform. Bacterial species were identified using the MTToolbox pipeline. Patients with hypoxemia, as indicated by a PaO2/FiO2 ratio 300, had a 30\{%} increase in abundance of Streptococcaceae and Enterobacteriaceae and 84\{%} increase in Staphylococcaceae as compared to patients with a PaO2/FiO2 ratio > 300. Wilcoxon rank-sum test identified significant enrichment in abundance of OTUs identified as Prevotella melaninogenica (p = 0.042), Corynebacterium (p = 0.037) and Mogibacterium (p = 0.048). Linear discriminant effect size analysis (LefSe) confirmed significant enrichment of Prevotella melaninognica among patients with a PaO2/FiO2 ratio 300 (p<0.05). These results could not be explained by differences in antibiotic treatment. Conclusions The airway microbiota following burn and inhalation injury is altered in patients with a PaO2/ FiO2 ratio 300 early after injury. Enrichment of specific taxa in patients with a PaO2/FiO2 ratio 300 may indicate airway environment and patient changes that favor these microbes. Longitudinal studies are necessary to identify stably colonizing taxa that play roles in hypoxemia and ARDS pathogenesis.",
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AU - Cairns,Bruce A.

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AU - Jaspers,Ilona

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N2 - Background Injury to the airways after smoke inhalation is a major mortality risk factor in victims of burn injuries, resulting in a 15±45% increase in patient deaths. Damage to the airways by smoke may induce acute respiratory distress syndrome (ARDS), which is partly characterized by hypoxemia in the airways. While ARDS has been associated with bacterial infection, the impact of hypoxemia on airway microbiota is unknown. Our objective was to identify differences in microbiota within the airways of burn patients who develop hypoxemia early after inhalation injury and those that do not using next-generation sequencing of bacterial 16S rRNA genes. Results DNA was extracted from therapeutic bronchial washings of 48 patients performed within 72 hours of hospitalization for burn and inhalation injury at the North Carolina Jaycee Burn Center. DNA was prepared for sequencing using a novel molecule tagging method and sequenced on the Illumina MiSeq platform. Bacterial species were identified using the MTToolbox pipeline. Patients with hypoxemia, as indicated by a PaO2/FiO2 ratio 300, had a 30% increase in abundance of Streptococcaceae and Enterobacteriaceae and 84% increase in Staphylococcaceae as compared to patients with a PaO2/FiO2 ratio > 300. Wilcoxon rank-sum test identified significant enrichment in abundance of OTUs identified as Prevotella melaninogenica (p = 0.042), Corynebacterium (p = 0.037) and Mogibacterium (p = 0.048). Linear discriminant effect size analysis (LefSe) confirmed significant enrichment of Prevotella melaninognica among patients with a PaO2/FiO2 ratio 300 (p<0.05). These results could not be explained by differences in antibiotic treatment. Conclusions The airway microbiota following burn and inhalation injury is altered in patients with a PaO2/ FiO2 ratio 300 early after injury. Enrichment of specific taxa in patients with a PaO2/FiO2 ratio 300 may indicate airway environment and patient changes that favor these microbes. Longitudinal studies are necessary to identify stably colonizing taxa that play roles in hypoxemia and ARDS pathogenesis.

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