The Journal of Infectious Diseases · 17 authors, 20 centres
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In a prospective cohort of 74 pediatric allo-HCT recipients, pre-conditioning and neutrophil-recovery fecal microbiota ratios predicted infection and acute GVHD outcomes. Specifically, a ratio of strict and facultative anaerobes before conditioning predicted bacteremia, and an oral-to-intestinal anaerobe ratio at neutrophil recovery predicted bacterial infections and viral enterocolitis.
This prospective observational study collected fecal samples from 74 children before conditioning and at neutrophil recovery, analyzing microbiome signatures via 16S rRNA gene sequencing. Cox proportional hazards analysis examined associations with infections and acute GVHD (aGVHD) in the first year post-HCT. Unlike adult cohorts, overall microbiota disruption did not predict infection risk. A pre-conditioning ratio of strict and facultative anaerobes (e.g., Lachnoclostridium, Parabacteroides) predicted bacteremia (HR, 3.89). Two microbiome signatures also predicted aGVHD. Limitations include cohort heterogeneity, use of targeted 16S amplicon sequencing (bacterial component only), sample exclusions, insufficient events for some outcomes, and the correlational nature of this single-cohort observational design. The findings suggest microbiota compositions at preconditioning and neutrophil recovery may serve as biomarkers for risk stratification.
