title: Membership and behavior of ultra-low-diversity pathogen communities present in the gut of humans during prolonged critical illness.
abstract: We analyzed the 16S rRNA amplicon composition in fecal samples of selected patients during their prolonged stay in an intensive care unit (ICU) and observed the emergence of ultra-low-diversity communities (1 to 4 bacterial taxa) in 30% of the patients. Bacteria associated with the genera Enterococcus and Staphylococcus and the family Enterobacteriaceae comprised the majority of these communities. The composition of cultured species from stool samples correlated to the 16S rRNA analysis and additionally revealed the emergence of Candida albicans and Candida glabrata in ~75% of cases. Four of 14 ICU patients harbored 2-member pathogen communities consisting of one Candida taxon and one bacterial taxon. Bacterial members displayed a high degree of resistance to multiple antibiotics. The virulence potential of the 2-member communities was examined in C. elegans during nutrient deprivation and exposure to opioids in order to mimic local conditions in the gut during critical illness. Under conditions of nutrient deprivation, the bacterial members attenuated the virulence of fungal members, leading to a "commensal lifestyle." However, exposure to opioids led to a breakdown in this commensalism in 2 of the ultra-low-diversity communities. Application of a novel antivirulence agent (phosphate-polyethylene glycol [Pi-PEG]) that creates local phosphate abundance prevented opioid-induced virulence among these pathogen communities, thus rescuing the commensal lifestyle. To conclude, the gut microflora in critically ill patients can consist of ultra-low-diversity communities of multidrug-resistant pathogenic microbes. Local environmental conditions in gut may direct pathogen communities to adapt to either a commensal style or a pathogenic style.
  
  
  OBJECTIVE
  During critical illness, the normal gut microbiota becomes disrupted in response to host physiologic stress and antibiotic treatment. Here we demonstrate that the community structure of the gut microbiota during prolonged critical illness is dramatically changed such that in many cases only two-member pathogen communities remain. Most of these ultra-low-membership communities display low virulence when grouped together (i.e., a commensal lifestyle); individually, however, they can express highly harmful behaviors (i.e., a pathogenic lifestyle). The commensal lifestyle of the whole community can be shifted to a pathogenic one in response to host factors such as opioids that are released during physiologic stress and critical illness. This shift can be prevented by using compounds such as Pi-PEG15-20 that interrupt bacterial virulence expression. Taking the data together, this report characterizes the plasticity seen with respect to the choice between a commensal lifestyle and a pathogenic lifestyle among ultra-low-diversity pathogen communities that predominate in the gut during critical illness and offers novel strategies for prevention of sepsis.
authors.affiliation: University of Chicago, Chicago, Illinois, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Zaborin
authors.affiliation: Argonne National Laboratory, Argonne, Illinois, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Smith
authors.affiliation: Michigan State University, East Lansing, Michigan, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Garfield
authors.affiliation: Michigan State University, East Lansing, Michigan, USA.
authors.forename: John
authors.initials: J
authors.lastname: Quensen
authors.affiliation: University of Chicago, Chicago, Illinois, USA.
authors.forename: Baddr
authors.initials: B
authors.lastname: Shakhsheer
authors.affiliation: University of Chicago, Chicago, Illinois, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Kade
authors.affiliation: University of Chicago, Chicago, Illinois, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Tirrell
authors.affiliation: Michigan State University, East Lansing, Michigan, USA.
authors.forename: James
authors.initials: J
authors.lastname: Tiedje
authors.forename: Jack A
authors.initials: JA
authors.lastname: Gilbert
authors.affiliation: University of Chicago, Chicago, Illinois, USA jalverdy@surgery.bsd.uchicago.edu ozaborin@surgery.bsd.uchicago.edu.
authors.forename: Olga
authors.initials: O
authors.lastname: Zaborina
authors.affiliation: University of Chicago, Chicago, Illinois, USA jalverdy@surgery.bsd.uchicago.edu ozaborin@surgery.bsd.uchicago.edu.
authors.forename: John C
authors.initials: JC
authors.lastname: Alverdy
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017173:Caenorhabditis elegans / Q000382:microbiology; D002176:Candida albicans / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D016638:Critical Illness; D024881:Drug Resistance, Bacterial; D025141:Drug Resistance, Fungal; D004755:Enterobacteriaceae / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D016983:Enterococcus / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology; D041981:Gastrointestinal Tract / Q000382:microbiology*; D020869:Gene Expression Profiling; D006801:Humans; D007362:Intensive Care Units; D064307:Microbiota; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D018805:Sepsis / Q000382:microbiology / Q000517:prevention & control; D013210:Staphylococcus / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D037521:Virulence Factors / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D012336:RNA, Ribosomal, 16S; D037521:Virulence Factors