title: The microbiome in mechanically ventilated patients.
abstract: OBJECTIVE
  Discovery of a normal lung microbiome requires reassessment of our concepts of HAP/VAP pathogenesis and has important implications for clinical diagnosis and management.
  
  
  RESULTS
  Changes in the microbiome of dental plaque are associated with increased risk of HAP/VAP. A transition to a lung microbiome enriched with gut flora is found in ARDS with an increased inflammatory response in patients with this change in microbial flora. A characteristic microbiome pattern of higher amounts of bacterial DNA, lower community diversity, and greater relative abundance of a single species characterize pneumonia and occasionally identify bacteria not found in culture. The influence of the microbiome makes probiotics a logical strategy to prevent or ameliorate HAP/VAP but so far clinical support is unclear.
  
  
  CONCLUSIONS
  The presence of a normal lung microbiome and the interaction of that microbiome with other microbiota have an important but previously overlooked impact on the pathogenesis of HAP/VAP. Deep sequencing suggests that the repertoire of microorganisms and the pattern of bacterial communities associated with HAP/VAP remains incompletely understood but recent studies are adding greater clarity.
authors.affiliation: aDepartment of Infectious Disease and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China bPulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Yudong
authors.initials: Y
authors.lastname: Yin
authors.forename: Peter
authors.initials: P
authors.lastname: Hountras
authors.forename: Richard G
authors.initials: RG
authors.lastname: Wunderink
mesh_terms: D003428:Cross Infection / Q000382:microbiology* / Q000517:prevention & control; D003773:Dental Plaque / Q000382:microbiology; D000069196:Gastrointestinal Microbiome; D006801:Humans; D008168:Lung / Q000382:microbiology*; D064307:Microbiota; D018410:Pneumonia, Bacterial / Q000382:microbiology* / Q000517:prevention & control; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology* / Q000517:prevention & control; D019936:Probiotics / Q000627:therapeutic use; D012128:Respiratory Distress Syndrome / Q000382:microbiology