肠道菌群特征或能预测白血病化疗感染风险
创作:szx 审核:szx 2019年09月11日
  • 纳入97名接受新辅助化疗(IC)的急性髓系白血病患者,从治疗开始至中性粒细胞恢复期间,每两周收集一次口腔及粪便样本;
  • 在IC开始时,更高的粪便菌群多样性及更高的紫单胞菌科丰度与更高的无感染概率相关;
  • 粪便菌群的Shannon多样性可用于预测中心粒细胞减少期间的感染风险;
  • 在中性粒细胞恢复之前使用碳青霉烯抗生素超过72小时的患者,在中性粒细胞恢复时的粪便菌群α-多样性显著降低,且在恢复后有更高的感染几率。
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szx
Clinical Infectious Diseases上发表的一项最新研究,在近100名接受新辅助化疗的急性髓系白血病患者中发现,肠道菌群的多样性及组成与治疗期间的感染风险相关。
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Gut Microbiome Signatures are Predictive of Infectious Risk Following Induction Therapy for Acute Myeloid Leukemia

肠道菌群特征可预测急性髓系白血病治疗后的感染风险

10.1093/cid/ciz777

2019-08-22, Article

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BACKGROUND: The majority of studies providing insights on the influence of the microbiome on the health of hematologic malignancy patients have concentrated on the transplant setting. Herein, we sought to assess the predictive capacity of the gastrointestinal microbiome and its relationship to clinical outcomes, with a specific focus on infection, in patients with acute myeloid leukemia (AML).
METHODS: 16s rRNA based analysis was performed on oral swabs and stool samples obtained biweekly from baseline until neutrophil recovery following induction chemotherapy (IC) in 97 AML patients. Microbiome characteristics were correlated with clinical outcomes both during and after IC completion.
RESULTS: At the start of IC, higher stool Shannon diversity (HR, 0.36; 95% CI, 0.18-0.74) and higher relative abundance of Porphyromonadaceae (HR, 0.36; 95% CI, 0.18-0.73) were associated with increased probability of remaining infection-free during neutropenia. A baseline stool Shannon diversity cut-off of <2 had optimal operating characteristics for predicting infectious complications during neutropenia. Although 56 patients received therapy >72 hours with a carbapenem, none of the patients had an infection with an extended spectrum beta-lactamase (ESBL) producing organism. Patients receiving carbapenems for >72hrs prior to neutrophil recovery had significantly lower α-diversity at neutrophil recovery (P=0.001) and were approximately 4 times more likely to have infection in the 90 days following neutrophil recovery (HR, 4.55; 95% CI, 1.73-11.93).
CONCLUSIONS: Our results suggest that gut microbiome evaluation could assist with infectious risk stratification and that improved targeting of antibiotic administration during IC could decrease subsequent infectious complications of AML patients.

First Authors:
Jessica R Galloway-Peña

Correspondence Authors:
Samuel A Shelburne

All Authors:
Jessica R Galloway-Peña,Yushu Shi,Christine B Peterson,Pranoti Sahasrabhojane,Vancheswaran Gopalakrishnan,Chelcy E Brumlow,Naval G Daver,Mansour Alfayez,Prajwal C Boddu,Md Abdul Wadud Khan,Jennifer A Wargo,Kim-Anh Do,Robert R Jenq,Dimitrios P Kontoyiannis,Samuel A Shelburne

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