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Dysbiosis of the gut microbiota is associated with in-hospital mortality in patients with antibiotic-associated diarrhoea: A metagenomic analysis

Authors
 Min Hyuk Choi  ;  Dokyun Kim  ;  Kyoung Hwa Lee  ;  Hyeon Jin Kim  ;  Woo Jun Sul  ;  Seok Hoon Jeong 
Citation
 INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS, Vol.64(5) : 107330, 2024-11 
Journal Title
INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS
ISSN
 0924-8579 
Issue Date
2024-11
MeSH
Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents* / adverse effects ; Anti-Bacterial Agents* / therapeutic use ; Clostridioides difficile / drug effects ; Clostridioides difficile / genetics ; Clostridioides difficile / isolation & purification ; Clostridium Infections* / microbiology ; Clostridium Infections* / mortality ; Diarrhea* / microbiology ; Diarrhea* / mortality ; Dysbiosis* / microbiology ; Feces* / microbiology ; Female ; Gastrointestinal Microbiome* / drug effects ; Gastrointestinal Microbiome* / genetics ; Hospital Mortality* ; Humans ; Machine Learning ; Male ; Metagenomics* ; Middle Aged
Keywords
Antibiotic-associated diarrhoea ; Clostridioides difficile ; Microbiome ; Microbiota ; Risk factors
Abstract
Background: The increasing incidence of antibiotic-associated diarrhoea (AAD) is a serious health care problem. Dysbiosis of the gut microbiota is suspected to play a role in the pathogenesis of AAD, but its impact on the clinical outcomes of patients remains unclear.

Methods: Between May and October 2022, 210 patients with AAD admitted to a university hospital and 100 healthy controls were recruited. DNA extraction from stool specimens and shotgun sequencing were performed. Machine learning was conducted to assess profiling at different taxonomic levels and to select variables for multivariable analyses.

Results: Patients were classified into two groups: Clostridioides difficile infection (CDI, n = 39) and non-CDI AAD (n = 171). The in-hospital mortality rate for the patients was 20.0%, but the presence of C. difficile in the gut microbiota was not associated with mortality. Machine learning showed that taxonomic profiling at the genus level best reflected patient prognosis. The in-hospital mortality of patients was associated with the relative abundance of specific gut microbial genera rather than alpha-diversity: each of the five genera correlated either positively (Enterococcus, Klebsiella, Corynebacterium, Pseudomonas, and Anaerofustis) or negatively (Bifidobacterium, Bacteroides, Streptococcus, Faecalibacterium, and Dorea). Genes for vancomycin resistance were significantly associated with in-hospital mortality in patients with AAD (adjusted hazard ratios, 2.45; 95% CI, 1.20-4.99).

Conclusion: This study demonstrates the potential utility of metagenomic studies of the gut microbial community as a biomarker for prognosis prediction in AAD patients.
Full Text
https://linkinghub.elsevier.com/retrieve/pii/S0924-8579(24)00246-2
DOI
10.1016/j.ijantimicag.2024.107330
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dokyun(김도균) ORCID logo https://orcid.org/0000-0002-0348-5440
Lee, Kyoung Hwa(이경화) ORCID logo https://orcid.org/0000-0003-0033-1398
Jeong, Seok Hoon(정석훈) ORCID logo https://orcid.org/0000-0001-9290-897X
Choi, Min Hyuk(최민혁) ORCID logo https://orcid.org/0000-0001-9801-9874
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/201643
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