The importance of airway and lung microbiome in the critically ill
Abstract During critical illness, there are a multitude of forces such as antibiotic use, mechanical ventilation, diet changes and inflammatory responses that could bring the microbiome out of balance. This so-called dysbiosis of the microbiome seems to be involved in immunological responses and may...
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doaj-c5eb59c304c842a49513b6ef8d959b392020-11-25T03:26:08ZengBMCCritical Care1364-85352020-08-012411910.1186/s13054-020-03219-4The importance of airway and lung microbiome in the critically illIgnacio Martin-Loeches0Robert Dickson1Antoni Torres2Håkan Hanberger3Jeffrey Lipman4Massimo Antonelli5Gennaro de Pascale6Fernando Bozza7Jean Louis Vincent8Srinivas Murthy9Michael Bauer10John Marshall11Catia Cilloniz12Lieuwe D. Bos13Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James HospitalDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of MichiganDeparment of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes)Department of Infectious Diseases, Linköping UniversityThe University of QueenslandDepartment of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCSDepartment of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCSNational Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, FiocruzDepartment of Intensive Care, Erasme University Hospital, Université Libre de BruxellesUniversity of British ColumbiaDepartment of Anesthesiology and Intensive Care Medicine, Jena University HospitalThe Keenan Research Centre for Biomedical Science, The Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of TorontoDeparment of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes)Department of Respiratory Medicine, Infection and Immunity, Amsterdam University Medical Center, AMCAbstract During critical illness, there are a multitude of forces such as antibiotic use, mechanical ventilation, diet changes and inflammatory responses that could bring the microbiome out of balance. This so-called dysbiosis of the microbiome seems to be involved in immunological responses and may influence outcomes even in individuals who are not as vulnerable as a critically ill ICU population. It is therefore probable that dysbiosis of the microbiome is a consequence of critical illness and may, subsequently, shape an inadequate response to these circumstances. Bronchoscopic studies have revealed that the carina represents the densest site of bacterial DNA along healthy airways, with a tapering density with further bifurcations. This likely reflects the influence of micro-aspiration as the primary route of microbial immigration in healthy adults. Though bacterial DNA density grows extremely sparse at smaller airways, bacterial signal is still consistently detectable in bronchoalveolar lavage fluid, likely reflecting the fact that lavage via a wedged bronchoscope samples an enormous surface area of small airways and alveoli. The dogma of lung sterility also violated numerous observations that long predated culture-independent microbiology. The body’s resident microbial consortia (gut and/or respiratory microbiota) affect normal host inflammatory and immune response mechanisms. Disruptions in these host-pathogen interactions have been associated with infection and altered innate immunity. In this narrative review, we will focus on the rationale and current evidence for a pathogenic role of the lung microbiome in the exacerbation of complications of critical illness, such as acute respiratory distress syndrome and ventilator-associated pneumonia.http://link.springer.com/article/10.1186/s13054-020-03219-4PneumoniaMicrobiomeInfectionVentilator-associated pneumoniaVentilator-associated tracheobronchitis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ignacio Martin-Loeches Robert Dickson Antoni Torres Håkan Hanberger Jeffrey Lipman Massimo Antonelli Gennaro de Pascale Fernando Bozza Jean Louis Vincent Srinivas Murthy Michael Bauer John Marshall Catia Cilloniz Lieuwe D. Bos |
spellingShingle |
Ignacio Martin-Loeches Robert Dickson Antoni Torres Håkan Hanberger Jeffrey Lipman Massimo Antonelli Gennaro de Pascale Fernando Bozza Jean Louis Vincent Srinivas Murthy Michael Bauer John Marshall Catia Cilloniz Lieuwe D. Bos The importance of airway and lung microbiome in the critically ill Critical Care Pneumonia Microbiome Infection Ventilator-associated pneumonia Ventilator-associated tracheobronchitis |
author_facet |
Ignacio Martin-Loeches Robert Dickson Antoni Torres Håkan Hanberger Jeffrey Lipman Massimo Antonelli Gennaro de Pascale Fernando Bozza Jean Louis Vincent Srinivas Murthy Michael Bauer John Marshall Catia Cilloniz Lieuwe D. Bos |
author_sort |
Ignacio Martin-Loeches |
title |
The importance of airway and lung microbiome in the critically ill |
title_short |
The importance of airway and lung microbiome in the critically ill |
title_full |
The importance of airway and lung microbiome in the critically ill |
title_fullStr |
The importance of airway and lung microbiome in the critically ill |
title_full_unstemmed |
The importance of airway and lung microbiome in the critically ill |
title_sort |
importance of airway and lung microbiome in the critically ill |
publisher |
BMC |
series |
Critical Care |
issn |
1364-8535 |
publishDate |
2020-08-01 |
description |
Abstract During critical illness, there are a multitude of forces such as antibiotic use, mechanical ventilation, diet changes and inflammatory responses that could bring the microbiome out of balance. This so-called dysbiosis of the microbiome seems to be involved in immunological responses and may influence outcomes even in individuals who are not as vulnerable as a critically ill ICU population. It is therefore probable that dysbiosis of the microbiome is a consequence of critical illness and may, subsequently, shape an inadequate response to these circumstances. Bronchoscopic studies have revealed that the carina represents the densest site of bacterial DNA along healthy airways, with a tapering density with further bifurcations. This likely reflects the influence of micro-aspiration as the primary route of microbial immigration in healthy adults. Though bacterial DNA density grows extremely sparse at smaller airways, bacterial signal is still consistently detectable in bronchoalveolar lavage fluid, likely reflecting the fact that lavage via a wedged bronchoscope samples an enormous surface area of small airways and alveoli. The dogma of lung sterility also violated numerous observations that long predated culture-independent microbiology. The body’s resident microbial consortia (gut and/or respiratory microbiota) affect normal host inflammatory and immune response mechanisms. Disruptions in these host-pathogen interactions have been associated with infection and altered innate immunity. In this narrative review, we will focus on the rationale and current evidence for a pathogenic role of the lung microbiome in the exacerbation of complications of critical illness, such as acute respiratory distress syndrome and ventilator-associated pneumonia. |
topic |
Pneumonia Microbiome Infection Ventilator-associated pneumonia Ventilator-associated tracheobronchitis |
url |
http://link.springer.com/article/10.1186/s13054-020-03219-4 |
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