Caratterizzazione del microbiota intestinale e polmonare in pazienti neurolesi e non-neurolesi ricoverati in Terapia Intensiva: studio osservazionale prospettico

Abstract

Introduzione. Nei pazienti critici ricoverati in Terapia Intensiva il microbiota intestinale e polmonare può alterarsi profondamente. Lo studio confronta pazienti neuro (neurolesi) e non-neuro e valuta possibili co-modificazioni intestino–polmone nel tempo. Metodi. Studio osservazionale, prospettico, traslazionale, monocentrico. Arruolati 124 pazienti (74 neuro, 50 non-neuro). Campioni biologici residui da procedure clinico-assistenziali raccolti a T1 (ingresso) e T2 (7–14 giorni): 244 campioni fecali e 78 lavaggi broncoalveolari. Analisi: estrazione DNA, amplificazione 16S rRNA e sequenziamento NGS. Pipeline QIIME2; α/β-diversity (test non parametrici, PERMANOVA) e identificazione di taxa discriminanti con LEfSe. Esplorata l’associazione con NSE e S100b. Risultati. A livello intestinale predominano Firmicutes, Proteobacteria, Actinobacteria e Bacteroidetes. Agathobaculum è maggiormente rappresentato nei neuro a T1 e quasi assente negli altri gruppi; altri taxa mostrano variazioni significative. L’α-diversity varia tra gruppi e tempi; la β-diversity evidenzia differenze soprattutto nei neuro a T1. Nel comparto polmonare, nei non-neuro si osservano variazioni tra T1 e T2 con aumento relativo di Proteobacteria. LEfSe identifica nel gruppo neuro a T2 biomarcatori, tra cui Pseudomonas e Staphylococcus. Non emergono correlazioni significative tra principali taxa intestinali e NSE/S100b. Nei neuro è descritta una maggiore co-variabilità intestino–polmone. Conclusioni. Nei pazienti critici il microbiota differisce tra neuro e non-neuro e cambia nel tempo, con segnali di disbiosi e possibili pattern coordinati intestino–polmone.

Introduction. In critically ill patients admitted to the Intensive Care Unit, the intestinal and pulmonary microbiota may undergo profound alterations. This study compares neuro (neuroinjured) and non-neuro patients and evaluates possible gut–lung co-modifications over time. Methods. Observational, prospective, translational, single-center study. A total of 124 patients were enrolled (74 neuro, 50 non-neuro). Residual biological samples from routine clinical procedures were collected at T1 (admission) and T2 (7–14 days): 244 fecal samples and 78 bronchoalveolar lavages. Analyses included DNA extraction, 16S rRNA gene amplification, and next-generation sequencing. Data were processed using QIIME2; α- and β-diversity were assessed with non-parametric tests and PERMANOVA, and discriminant taxa were identified using LEfSe. Associations with NSE and S100b were explored. Results. At the intestinal level, Firmicutes, Proteobacteria, Actinobacteria, and Bacteroidetes predominated. Agathobaculum was more represented in neuro patients at T1 and nearly absent in other groups; additional taxa showed significant variations. α-diversity differed across groups and time points, while β-diversity showed significant differences mainly in neuro patients at T1. In the pulmonary compartment, non-neuro patients showed changes between T1 and T2, with a relative increase in Proteobacteria. LEfSe identified biomarkers in neuro patients at T2, including Pseudomonas and Staphylococcus. No significant correlations were found between major intestinal taxa and NSE/S100b levels. Greater gut–lung co-variability was observed in neuro patients. Conclusions. In critically ill patients, the microbiota differs between neuro and non-neuro groups and changes over time, with signals of dysbiosis and possible coordinated gut–lung patterns.