Longitudinal dysbiosis of gut bacteriome and mycobiome in patients with severe acute pancreatitis and its association with mortality.

BACKGROUND

The dysbiosis of gut microbiome is known to have a significant impact on the progression of sever acute pancreatitis (SAP). This study intends to investigate the alteration of gut microbiome in SAP patients during hospitalization and its association with mortality. Bacterial and fungal compositions of the fecal microbiota were determined via 16S and ITS1 sequencing, respectively.

RESULTS

Our findings indicated that SAP patients exhibited bacterial and fungal dysbiosis either at the time of admission or within the first 72 h of admission prior to any antibiotic treatment, characterized by reduced biodiversity, lower abundances of Blautia, Bifidobacterium, and increased Escherichia-Shigella, Enterococcus, and Candida. The overall microbiome was partially restored post-treatment in survivors, including commensal Bifidobacterium enhancement. In contrast, non-survivors experienced sustained perturbations during hospitalization, with over-representation of pathogenic Enterococcus and Candida. A classifier based on 20 optimal bacteria markers showed superior efficiency for predicting mortality. Interestingly, the abundances of Acinetobacter, Klebsiella and Candida were considerably elevated in the gut of patients who subsequently developed infectious complications.

CONCLUSIONS

Our study provided a comprehensive profile of gut bacteriome and mycobiome in SAP patients and identified the temporal trajectory alterations of microbiome associated with mortality. These findings underscore the importance of early recognition of pathobiome states and the potential role for the modulation of microbiota during the development of SAP.