Background

Whether there is any benefit in integrating culture-independent molecular analysis of the lower airway microbiota of people with cystic fibrosis into clinical care is unclear. This study determined the longitudinal trajectory of the microbiota and if there were microbiota characteristics that corresponded with response to treatment or predicted a future pulmonary exacerbation.

Methods

At least one sputum sample was collected from 149 participants enrolled in this prospective longitudinal multi-centre study and total bacterial density and microbiota community measurements were determined and compared with clinical parameters.

Results

In 114 participants with paired samples when clinically stable, ∼8 months apart, the microbiota remained conserved between timepoints, regardless of whether participants received acute intravenous antibiotic treatment or not. In 62 participants, who presented with an acute exacerbation, a decrease in community richness correlated best with patient response to antibiotic treatment. Analysis of baseline samples from 30 participants who exacerbated within 4 months of their stable sample being collected and 72 participants who remained stable throughout the study showed that community characteristics such as lower richness at baseline may be predictive of an exacerbation in addition to several clinical parameters. However, lasso regression analysis indicated that only lung function (p = 0.014) was associated with a future exacerbation.

Conclusions

The airway microbiota remains stable over periods <1 year with modest shifts related to treatment apparent which might provide some additional insights to patient-level measurements.

中文翻译：

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囊性纤维化气道微生物群随时间和治疗的纵向变化

背景

将囊性纤维化患者下气道微生物群的独立于培养的分子分析整合到临床护理中是否有任何益处尚不清楚。这项研究确定了微生物群的纵向轨迹，以及是否存在与治疗反应相对应或预测未来肺部病情恶化的微生物群特征。

方法

从参与这项前瞻性纵向多中心研究的 149 名参与者中至少收集了一份痰样本，确定了总细菌密度和微生物群落测量值，并与临床参数进行比较。

结果

在 114 名临床稳定且相隔约 8 个月的配对样本参与者中，无论参与者是否接受急性静脉注射抗生素治疗，微生物群在不同时间点之间保持保守。在 62 名出现急性加重的参与者中，群落丰富度的下降与患者对抗生素治疗的反应最相关。对 30 名在收集稳定样本后 4 个月内病情恶化的参与者和 72 名在整个研究过程中保持稳定的参与者的基线样本进行的分析表明，除了一些临床参数之外，群落特征（例如基线丰富度较低）可能是病情恶化的预测因素。然而，套索回归分析表明，只有肺功能（p  = 0.014）与未来的病情恶化相关。

结论

气道微生物群在不到 1 年的时间内保持稳定，与明显的治疗相关的适度变化可能为患者水平的测量提供一些额外的见解。