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Article ; Online: Monitoring pediatric eosinophilic esophagitis disease activity using an unsedated blind esophageal brushing model: A pilot study.

Thomas, Jessina / Deb, Chirajyoti / Bittar, Khaled / Bornstein, Jeffrey / Mehta, Devendra / Smadi, Yamen

Journal of pediatric gastroenterology and nutrition

2024 Volume 78, Issue 4, Page(s) 878–885

Abstract: Background: Recurrent upper endoscopies are essential for monitoring therapy response and disease activity in patients with eosinophilic esophagitis (EoE), leading to increased costs, procedural complications, and anesthesia exposure. The aim of this ... ...

Abstract	Background: Recurrent upper endoscopies are essential for monitoring therapy response and disease activity in patients with eosinophilic esophagitis (EoE), leading to increased costs, procedural complications, and anesthesia exposure. The aim of this study was to examine an office-based model using serial sedation-free blind esophageal epithelial brushing (BEEB) to monitor therapy response through eosinophil-derived neurotoxin (EDN) levels and guide therapy plans in pediatric EoE patients. Methods: EoE patients (≤21 years of age) were enrolled in this prospective study. Subjects were placed on dietary, pharmacologic, or combination therapy with the goal of inducing or maintaining remission. To assess response to sequential interventions, subjects underwent sequential sedation-free BEEBs through nasogastric tubes to measure EDN levels. Based on serial brushings, an individual plan of diet, medications, or a combination of both was created for each subject, and a final endoscopy was then performed to validate the accuracy of the individual plans. Results: Twenty-four subjects completed the study. The average peak eosinophil count in patients with active EoE was 58.1 ± 30.8 eosinophils per high-power field and mean EDN level was 165.2 ± 191.3 μg/mL. A total of 42 BEEBs were completed. Individual therapy plans based on sequential BEEB were accurate in 19 out of the 24 patients (79%) and specifically nine out of 10 patients (90%) treated with elimination diets. Conclusion: This study suggests that office-based sedation-free BEEBs can be used to monitor therapy response and disease activity in pediatric EoE patients.
MeSH term(s)	Humans ; Child ; Eosinophilic Esophagitis/diagnosis ; Eosinophilic Esophagitis/therapy ; Pilot Projects ; Prospective Studies ; Eosinophils ; Enteritis ; Eosinophilia ; Gastritis
Language	English
Publishing date	2024-01-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	603201-1
ISSN	1536-4801 ; 0277-2116
ISSN (online)	1536-4801
ISSN	0277-2116
DOI	10.1002/jpn3.12127
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Article ; Online: Addressing diagnostic dilemmas in eosinophilic esophagitis using esophageal epithelial eosinophil-derived neurotoxin.

Thomas, Jessina / Hopson, Puanani / Deb, Chirajyoti / Bornstein, Jeffrey / Mehta, Devendra / Bittar, Khaled / Smadi, Yamen

Journal of pediatric gastroenterology and nutrition

2023 Volume 78, Issue 2, Page(s) 304–312

Abstract: Objectives: Eosinophil-derived neurotoxin (EDN) is a viable marker of eosinophilic esophagitis (EoE) disease activity. We studied the utility of measuring EDN from esophageal epithelial brushings for diagnosing EoE, focusing on two scenarios: (1) cases ... ...

Abstract	Objectives: Eosinophil-derived neurotoxin (EDN) is a viable marker of eosinophilic esophagitis (EoE) disease activity. We studied the utility of measuring EDN from esophageal epithelial brushings for diagnosing EoE, focusing on two scenarios: (1) cases of exclusive distal eosinophilia and (2) cases of discrepancy between endoscopy and histology. Methods: Records of patients who underwent esophagogastroduodenoscopy (EGD) with EDN measured via esophageal brushings at Arnold Palmer Hospital for Children in Orlando, Florida from January 2014 to October 2018 were retrospectively reviewed. Demographics, clinical, endoscopic, and histologic data were collected. Results: We reviewed 231 patient records (66.7% male, mean age 10.3 years, range 1-22 years). EDN values correlated with endoscopic reference score (EREFS) and peak eosinophil count (PEC) (Spearman's rho = 0.756 (p < 0.001) and 0.824 (p < 0.001) respectively). Average PEC, EREFS, and EDN concentrations were higher in patients with active EoE than in controls or patients with EoE in remission (inactive). When grouping patients based on esophageal eosinophilia distribution, EDN mirrored PEC, and EREFS. Patients with exclusive distal eosinophilia had lower EDN concentrations than those with eosinophilia in >1 level of the esophagus (23.8 ± 46.1 mcg/mL vs. 171.3 ± 205.8 mcg/mL respectively, p < 0.001). EDN values were more consistent with EREFS in cases of discrepancies between endoscopic findings and pathology (p < 0.001). Conclusion: EDN measured in esophageal brushing samples reflects disease activity objectively and accurately. It also offers significant value in cases of exclusive distal esophageal eosinophilia and when discrepancies exist between endoscopy and histology.
MeSH term(s)	Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Young Adult ; Enteritis ; Eosinophil-Derived Neurotoxin/chemistry ; Eosinophil-Derived Neurotoxin/metabolism ; Eosinophilia/diagnosis ; Eosinophilia/pathology ; Eosinophilic Esophagitis/diagnosis ; Eosinophilic Esophagitis/pathology ; Eosinophils/pathology ; Gastritis ; Retrospective Studies
Chemical Substances	Eosinophil-Derived Neurotoxin (EC 3.1.-)
Language	English
Publishing date	2023-12-27
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	603201-1
ISSN	1536-4801 ; 0277-2116
ISSN (online)	1536-4801
ISSN	0277-2116
DOI	10.1002/jpn3.12054
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Article ; Online: Gut Microbiome Remains Static in Functional Abdominal Pain Disorders Patients Compared to Controls: Potential for Diagnostic Tools.

Abomoelak, Bassam / Saps, Miguel / Sudakaran, Sailendharan / Deb, Chirajyoti / Mehta, Devendra

Biotech (Basel (Switzerland))

2022 Volume 11, Issue 4

Abstract: Background: Functional Abdominal Pain disorders (FAPDs) are a group of heterogeneous gastrointestinal disorders with unclear pathophysiology. In children, FAPDs are more common in the winter months than summer months. The possible influence of school ... ...

Abstract	Background: Functional Abdominal Pain disorders (FAPDs) are a group of heterogeneous gastrointestinal disorders with unclear pathophysiology. In children, FAPDs are more common in the winter months than summer months. The possible influence of school stressors has been proposed. Previously, our group showed differences in bacterial relative abundances and alpha diversity in the gut microbiome and its relationship with stressors in a cross-sectional evaluation of children suffering from FAPDs compared to a healthy control group. We present longitudinal data to assess whether the gut microbiome changes over school terms in the control and FAPDs groups. Methods: The longitudinal study included children with FAPDs (n = 28) and healthy controls (n = 54). Gastrointestinal symptoms, as well as stool microbiome, were assessed in both groups. Stool samples were serially collected from all participants during both the school term and summer vacation. The stool samples were subjected to total genomic extraction, 16S rRNA amplicon sequencing, and bioinformatics analysis. The gut microbiome was compared at school and during vacation. Other metrics, alpha diversity, and beta diversity, were also compared between the two school terms in every group. Results: In the healthy group, there were differences in microbiome composition between school terms and summer vacation. Conversely, we found no differences in the FAPDs group between the two terms. The healthy control group revealed differences (p-value < 0.05) in 55 bacterial species between the school term and vacation. Several of the differentially abundant identified bacteria were involved in short-chain fatty acids production (SCFAs), inflammation reduction, and gut homeostasis. Alpha diversity metrics, such as the Shannon index, were different in the control group and remained unchanged in the FAPDs group. Conclusion: Although preliminary, our findings suggest that the gut microbiome is static in FAPDs. This compares with a more dynamic healthy gut microbiome. Further studies are warranted to corroborate this and understand the interplay between stress, symptoms, and a less diverse and static microbiome. Future studies will also account for different variables such as diet and other patient demographic criteria that were missing in the current study.
Language	English
Publishing date	2022-10-27
Publishing country	Switzerland
Document type	Journal Article
ISSN	2673-6284
ISSN (online)	2673-6284
DOI	10.3390/biotech11040050
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Article ; Online: Microbiome profile informs cleansing and storage practices for reusable feeding tube stylets in critical care.

Bourgault, Annette M / Deb, Chirajyoti / Aguirre, Lillian / Xie, Rui / Rathbun, Kimberly Paige / Sole, Mary Lou

Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition

2022 Volume 38, Issue 2, Page(s) 411–424

Abstract: Background: Cleansing and storage practices for reusable feeding tube stylets are varied and lack consensus guidelines. Almost 40% of critical care nurses do not cleanse reusable stylets. Our proof-of-concept study aimed to identify potential microbial ... ...

Abstract	Background: Cleansing and storage practices for reusable feeding tube stylets are varied and lack consensus guidelines. Almost 40% of critical care nurses do not cleanse reusable stylets. Our proof-of-concept study aimed to identify potential microbial contamination of stylets before and after cleansing with 70% isopropyl alcohol to establish practice standards. Methods: This prospective, exploratory pilot study sampled reusable feeding tube stylets using three different stylet sample sets. Set 1 included human participant stylets sampled for microbiome profile precleansing, and postcleansing and reinsertion into feeding tubes (n = 4). Sets 2 and 3 included stylets stored at the bedside. Set 2 included precleansed stylets for microbiome profiles (n = 5). Set 3 included precleansed and postcleansed stylets sampled for quantitative cultures (n = 5). Careful handling and storage protocols were used. Microbiome profiling used 16s ribosomal RNA gene amplicon sequencing. Results: Bacterial species identified on stylets were primarily common microflora and opportunistic pathogens, including Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas fulva, Cutibacterium acnes, Prevotella melaninogenica, and Lactobacillus paracasei. Microbiological culturing of stylet samples (set 3) did not yield growth for 9/10 samples; Staphylococcus capitis was identified in one postcleansed sample. Mean bacterial species diversity (alpha diversity) decreased following alcohol cleansing (M = 2.54 pre, M = 1.5 post; P = 0.006). Conclusion: The abundance of several potentially opportunistic pathogens indicated plausible risk for gut contamination secondary to reinsertion of stylets into small-bore feeding tubes. Stylet cleansing with 70% isopropyl alcohol reduced bacterial burden on the stylets, although viability was unknown. Careful cleansing, handling, and storage protocols for reusable stylets are necessary to minimize contamination.
MeSH term(s)	Humans ; Prospective Studies ; Pilot Projects ; 2-Propanol ; Bacteria ; Microbiota ; Critical Care
Chemical Substances	2-Propanol (ND2M416302)
Language	English
Publishing date	2022-08-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	645074-x
ISSN	1941-2452 ; 0884-5336
ISSN (online)	1941-2452
ISSN	0884-5336
DOI	10.1002/ncp.10904
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Microbiome profile informs cleansing and storage practices for reusable feeding tube stylets in critical care

Bourgault, Annette M. / Deb, Chirajyoti / Aguirre, Lillian / Xie, Rui / Rathbun, Kimberly Paige / Sole, Mary Lou

Nutrition in Clinical Practice. 2023 Apr., v. 38, no. 2 p.411-424

2023

Abstract: BACKGROUND: Cleansing and storage practices for reusable feeding tube stylets are varied and lack consensus guidelines. Almost 40% of critical care nurses do not cleanse reusable stylets. Our proof‐of‐concept study aimed to identify potential microbial ... ...

Abstract	BACKGROUND: Cleansing and storage practices for reusable feeding tube stylets are varied and lack consensus guidelines. Almost 40% of critical care nurses do not cleanse reusable stylets. Our proof‐of‐concept study aimed to identify potential microbial contamination of stylets before and after cleansing with 70% isopropyl alcohol to establish practice standards. METHODS: This prospective, exploratory pilot study sampled reusable feeding tube stylets using three different stylet sample sets. Set 1 included human participant stylets sampled for microbiome profile precleansing, and postcleansing and reinsertion into feeding tubes (n = 4). Sets 2 and 3 included stylets stored at the bedside. Set 2 included precleansed stylets for microbiome profiles (n = 5). Set 3 included precleansed and postcleansed stylets sampled for quantitative cultures (n = 5). Careful handling and storage protocols were used. Microbiome profiling used 16s ribosomal RNA gene amplicon sequencing. RESULTS: Bacterial species identified on stylets were primarily common microflora and opportunistic pathogens, including Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas fulva, Cutibacterium acnes, Prevotella melaninogenica, and Lactobacillus paracasei. Microbiological culturing of stylet samples (set 3) did not yield growth for 9/10 samples; Staphylococcus capitis was identified in one postcleansed sample. Mean bacterial species diversity (alpha diversity) decreased following alcohol cleansing (M = 2.54 pre, M = 1.5 post; P = 0.006). CONCLUSION: The abundance of several potentially opportunistic pathogens indicated plausible risk for gut contamination secondary to reinsertion of stylets into small‐bore feeding tubes. Stylet cleansing with 70% isopropyl alcohol reduced bacterial burden on the stylets, although viability was unknown. Careful cleansing, handling, and storage protocols for reusable stylets are necessary to minimize contamination.
Keywords	Lactobacillus paracasei ; Prevotella melaninogenica ; Pseudomonas fulva ; Staphylococcus aureus ; Staphylococcus capitis ; Streptococcus pneumoniae ; digestive system ; genes ; humans ; isopropyl alcohol ; microbial contamination ; microbial load ; microbiome ; microorganisms ; nutrition ; ribosomal RNA ; risk ; species diversity ; stylets ; viability
Language	English
Dates of publication	2023-04
Size	p. 411-424.
Publishing place	John Wiley & Sons, Ltd
Document type	Article ; Online
Note	JOURNAL ARTICLE
ZDB-ID	645074-x
ISSN	1941-2452 ; 0884-5336
ISSN (online)	1941-2452
ISSN	0884-5336
DOI	10.1002/ncp.10904
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Eosinophil-Derived Neurotoxin Predicts Response to Proton-Pump Inhibitor Treatment in Pediatric Eosinophilic Esophagitis.

Irastorza, Laura E / Hopson, Puanani / Nabar, Shruti / Deb, Chirajyoti / Smadi, Yamen

Journal of pediatric gastroenterology and nutrition

2021 Volume 74, Issue 2, Page(s) 267–271

Abstract: Objectives: There are no tests or patient factors to help predict the best treatment approach for a patient with eosinophilic esophagitis (EoE). The prevalence of proton-pump inhibitor (PPI) responsive EoE in children ranges from 30% to 71% with ... ...

Abstract	Objectives: There are no tests or patient factors to help predict the best treatment approach for a patient with eosinophilic esophagitis (EoE). The prevalence of proton-pump inhibitor (PPI) responsive EoE in children ranges from 30% to 71% with multiple studies showing similar characteristics in responders and nonresponders. Eosinophil-derived neurotoxin (EDN), an eosinophilic granule protein, measured in esophageal brushing has been shown to be a viable measure of disease activity in EoE. Our aim is to determine if EDN can help predict response to PPI in pediatric patients with EoE. Methods: We conducted a prospective cross-sectional study to compare EDN between PPI-responsive and PPI-nonresponsive EoE subjects from 2018 through 2020. Enrolled patients with active EoE were treated with high-dose PPI and underwent repeat endoscopy to determine PPI-responsiveness. EDN was measured at baseline endoscopy, before any treatment, and at follow up endoscopy, after PPI therapy. Subjects were divided into PPI-responsive and nonresponsive groups. EDN, endoscopic reference score (EREFS), and peak eosinophilic count (PEC) were compared. Results: Fifteen out of the 36 enrolled subjects with EoE (age range 2-18 years, 73.3% male) were PPI-responsive and 21 (age range 2-19 years, 95.2% male) were PPI-nonresponsive. EDN concentration was significantly higher in the PPI-nonresponsive group than in the PPI-responsive group (219.1 ± 229 mcg/mL vs 75.7 ± 60 mcg/mL, respectively, P = 0.036). There was no difference between the two groups in EREFS (P = 0.55) or PEC (P = 0.15). Conclusions: EDN measured in esophageal epithelial samples obtained by brushing during endoscopy may predict PPI-responsiveness in children and young adults with EoE.
MeSH term(s)	Adolescent ; Child ; Child, Preschool ; Cross-Sectional Studies ; Eosinophil-Derived Neurotoxin ; Eosinophilic Esophagitis/drug therapy ; Female ; Humans ; Male ; Prospective Studies ; Proton Pump Inhibitors/therapeutic use ; Young Adult
Chemical Substances	Proton Pump Inhibitors ; Eosinophil-Derived Neurotoxin (EC 3.1.-)
Language	English
Publishing date	2021-04-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	603201-1
ISSN	1536-4801 ; 0277-2116
ISSN (online)	1536-4801
ISSN	0277-2116
DOI	10.1097/MPG.0000000000003257
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Article ; Online: Using Eosinophil Biomarkers From Rectal Epithelial Samples to Diagnose Food Protein-induced Proctocolitis: A Pilot Study.

de Boer, Justin / Deb, Chirajyoti / Bornstein, Jeffrey / Horvath, Karoly / Mehta, Devendra / Smadi, Yamen

Journal of pediatric gastroenterology and nutrition

2021 Volume 71, Issue 4, Page(s) e109–e112

Abstract: Objectives: The gold standard diagnostic procedure for food protein-induced proctocolitis (FPIP) requires flexible sigmoidoscopy (FS). To date there is no validated, noninvasive test to confirm FPIP diagnosis. Eosinophil-derived neurotoxin (EDN), a ... ...

Abstract	Objectives: The gold standard diagnostic procedure for food protein-induced proctocolitis (FPIP) requires flexible sigmoidoscopy (FS). To date there is no validated, noninvasive test to confirm FPIP diagnosis. Eosinophil-derived neurotoxin (EDN), a product of eosinophil (EOS) degranulation, has been shown to correlate with eosinophil infiltration in other tissues. Our objective was to compare EDN concentrations in rectal epithelial samples from infants with FPIP with those from a control population. Methods: Children who underwent routine FS at Arnold Palmer Hospital for Children were enrolled in an IRB-approved, prospective, open-label pilot study between July 2017 and May 2019. We obtained rectal epithelial samples via: rectal swab, cytology brushing through FS, and rectal biopsy through FS. We then measured EDN levels in the samples and compared levels found in infants with FPIP against levels found in the control group. FPIP was defined as more than 60 EOS per 10 high-power fields (HPF) in rectal epithelial tissue obtained via rectosigmoid biopsy. Results: Twenty-four patients were enrolled. The control group (n = 13) included patients with normal histopathology (84% boys, mean age 19 months, SD 6 months) and the FPIP group (n = 11) included patients with FPIP confirmed via biopsy (45% boys, mean age 6.9 months, SD 9 months). EDN concentration was significantly higher in the FPIP group than in the control group, for 2 sampling methods: rectal biopsy (183.6 ± 114.6 vs 76.6 ± 71.0 μg/mL; P = 0.010) and rectal swab (66.2 ± 64.8 vs 20.4 ± 22.2 μg/mL; P = 0.025). Conclusions: EDN concentrations measured from rectal swab and rectal biopsy samples is elevated and may be a useful tool to screen for FPIP in children.
MeSH term(s)	Biomarkers ; Child ; Eosinophil-Derived Neurotoxin ; Eosinophils ; Female ; Humans ; Infant ; Male ; Pilot Projects ; Proctocolitis/diagnosis ; Prospective Studies
Chemical Substances	Biomarkers ; Eosinophil-Derived Neurotoxin (EC 3.1.-)
Language	English
Publishing date	2021-02-02
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	603201-1
ISSN	1536-4801 ; 0277-2116
ISSN (online)	1536-4801
ISSN	0277-2116
DOI	10.1097/MPG.0000000000002812
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Article ; Online: Author Correction: A 1-minute blood test detects decreased immune function and increased clinical risk in COVID-19 patients.

Deb, Chirajyoti / Salinas, Allan N / Zheng, Tianyu / Middleton, Aurea / Kern, Katelyn / Penoyer, Daleen / Borsadia, Rahul / Hunley, Charles / Abomoelak, Bassam / Mehta, Vijay / Irastorza, Laura / Mehta, Devendra I / Huo, Qun

Scientific reports

2021 Volume 11, Issue 1, Page(s) 24461

Language	English
Publishing date	2021-12-21
Publishing country	England
Document type	Published Erratum
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-021-04067-0
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Pepsin A in Tracheal Secretions From Patients Receiving Mechanical Ventilation.

Talbert, Steven / Bourgault, Annette M / Rathbun, Kimberly Paige / Abomoelak, Bassam / Deb, Chirajyoti / Mehta, Devendra / Sole, Mary Lou

American journal of critical care : an official publication, American Association of Critical-Care Nurses

2021 Volume 30, Issue 6, Page(s) 443–450

Abstract: Background: In patients in the intensive care unit (ICU) receiving mechanical ventilation, aspiration of gastric contents may lead to ventilator-associated events and other adverse outcomes. Pepsin in pulmonary secretions is a biomarker of ... ...

Abstract	Background: In patients in the intensive care unit (ICU) receiving mechanical ventilation, aspiration of gastric contents may lead to ventilator-associated events and other adverse outcomes. Pepsin in pulmonary secretions is a biomarker of microaspiration of gastric contents. Objectives: To evaluate the association between tracheal pepsin A and clinical outcomes related to ventilator use. Methods: A subset of 297 patients from a larger clinical trial on aspiration of oral secretions in adults receiving mechanical ventilation consented to have pepsin A measured in their tracheal aspirate samples. A concentration ≥6.25 ng/mL indicated a positive result. Abundant microaspiration was defined as pepsin A in ≥30% of samples. Statistical analyses included analysis of variance, analysis of covariance, and χ2 tests. Results: Most patients were White men, mean age 59.7 (SD, 18.8) years. Microaspiration was found in 43.8% of patients (n = 130), with abundant microaspiration detected in 17.5% (n = 52). After acuity was controlled for, patients with tracheal pepsin A had a longer mechanical ventilation duration (155 vs 104 hours, P < .001) and ICU stay (9.9 vs 8.2 days, P = .04), but not a longer hospital stay. Conclusions: Microaspiration of gastric contents occurred in nearly half of patients and was associated with a longer duration of mechanical ventilation and a longer stay in the ICU. Additional preventative interventions beyond backrest elevation, oropharyngeal suctioning, and management of endotracheal tube cuff pressure may be needed. Also, the timing of pepsin measurements to capture all microaspiration events requires additional exploration.
MeSH term(s)	Adult ; Humans ; Intensive Care Units ; Intubation, Intratracheal ; Male ; Middle Aged ; Pepsin A ; Respiration, Artificial/adverse effects ; Trachea
Chemical Substances	Pepsin A (EC 3.4.23.1)
Language	English
Publishing date	2021-11-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1130987-8
ISSN	1937-710X ; 1062-3264
ISSN (online)	1937-710X
ISSN	1062-3264
DOI	10.4037/ajcc2021528
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Article ; Online: Pulmonary Microbiome of Patients Receiving Mechanical Ventilation: Changes Over Time.

Sole, Mary Lou / Yooseph, Shibu / Talbert, Steven / Abomoelak, Bassam / Deb, Chirajyoti / Rathbun, Kimberly Paige / Penoyer, Daleen / Middleton, Aurea / Mehta, Devendra

American journal of critical care : an official publication, American Association of Critical-Care Nurses

2021 Volume 30, Issue 2, Page(s) 128–132

Abstract: Background: Interest in the pulmonary microbiome is growing, particularly in patients undergoing mechanical ventilation.: Objectives: To explore the pulmonary microbiome over time in patients undergoing prolonged mechanical ventilation and to ... ...

Abstract	Background: Interest in the pulmonary microbiome is growing, particularly in patients undergoing mechanical ventilation. Objectives: To explore the pulmonary microbiome over time in patients undergoing prolonged mechanical ventilation and to evaluate the effect of an oral suctioning intervention on the microbiome. Methods: This descriptive subanalysis from a clinical trial involved a random sample of 16 participants (7 intervention, 9 control) who received mechanical ventilation for at least 5 days. Five paired oral and tracheal specimens were evaluated for each participant over time. Bacterial DNA from the paired specimens was evaluated using 16S rRNA gene sequencing. Bacterial taxonomy composition, α-diversity (Shannon index), and β-diversity (Morisita-Horn index) were calculated and compared within and between participants. Results: Participants were predominantly male (69%) and White (63%), with a mean age of 58 years, and underwent mechanical ventilation for a mean of 9.36 days. Abundant bacterial taxa included Prevotella, Staphylococcus, Streptococcus, Stenotrophomonas, and Veillonella. Mean tracheal α-diversity decreased over time for the total group (P = .002) and the control group (P = .02). β-Diversity was lower (P = .04) in the control group (1.905) than in the intervention group (2.607). Conclusions: Prolonged mechanical ventilation was associated with changes in the pulmonary microbiome, with the control group having less diversity. The oral suctioning intervention may have reduced oral-tracheal bacterial transmission.
MeSH term(s)	Bacteria/classification ; DNA, Bacterial/genetics ; Female ; Humans ; Lung/microbiology ; Male ; Microbiota ; Middle Aged ; RNA, Ribosomal, 16S/genetics ; Respiration, Artificial
Chemical Substances	DNA, Bacterial ; RNA, Ribosomal, 16S
Language	English
Publishing date	2021-02-26
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1130987-8
ISSN	1937-710X ; 1062-3264
ISSN (online)	1937-710X
ISSN	1062-3264
DOI	10.4037/ajcc2021194
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