Pathophysiological role of respiratory dysbiosis in hospital-acquired pneumonia
呼吸道失调在医院获得性肺炎中的病理生理作用
摘要：
Hospital-acquired pneumonia is a major cause of morbidity and mortality. The incidence of hospital-acquired pneumonia remains high globally and treatment can often be ineffective. Here, we review the available data and unanswered questions surrounding hospital-acquired pneumonia, discuss alterations of the respiratory microbiome and of the mucosal immunity in patients admitted to hospital, and explore potential approaches to stratify patients for tailored treatments. The lungs have been considered a sterile organ for decades because microbiological culture techniques had shown negative results. Culture-independent techniques have shown that healthy lungs harbour a diverse and dynamic ecosystem of bacteria, changing our comprehension of respiratory physiopathology. Understanding dysbiosis of the respiratory microbiome and altered mucosal immunity in patients with critical illness holds great promise to develop targeted host-directed immunotherapy to reduce ineffective treatment, to improve patient outcomes, and to tackle the global threat of resistant bacteria that cause these infections.
医院获得性肺炎是发病率和死亡率的主要原因。全球医院获得性肺炎的发病率仍然很高，治疗往往无效。在这里，我们回顾了有关医院获得性肺炎的现有数据和未解答的问题，讨论了入院患者呼吸微生物组织和粘膜免疫的改变，并探索了对患者进行定制治疗的潜在方法。几十年来，肺被认为是一种不育器官，因为微生物培养技术已经显示出负面结果。独立于文化的技术表明，健康的肺部拥有多样且充满活力的细菌生态系统，改变了我们对呼吸道病理学的理解。 了解呼吸微生物组的生态失调和危重疾病患者的粘膜免疫力改变，有望开发靶向宿主导向免疫疗法，以减少无效治疗，改善患者预后，并应对导致这些感染的耐药细菌的全球威胁。