Gut to lung translocation and antibiotic mediated selection shape the dynamics of Pseudomonas aeruginosa in an ICU patient

Rachel M. Wheatley, Julio Diaz Caballero, Thomas E. Schalk, Fien H. R. Winter, Liam P. Shaw, Natalia Kapel, Claudia Recanatini, Leen Timbermont, Jan Kluytmans, Mark Esser, Alicia Lacoma, Cristina Prat-Aymerich, Antonio Oliver, Samir Kumar-Singh, Surbhi Malhotra-Kumar and R. Craig MacLean ()
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Rachel M. Wheatley: University of Oxford, Department of Biology
Julio Diaz Caballero: University of Oxford, Department of Biology
Thomas E. Schalk: University of Antwerp
Fien H. R. Winter: University of Antwerp
Liam P. Shaw: University of Oxford, Department of Biology
Natalia Kapel: University of Oxford, Department of Biology
Claudia Recanatini: University Medical Center Utrecht, Utrecht University
Leen Timbermont: University of Antwerp
Jan Kluytmans: University Medical Center Utrecht, Utrecht University
Mark Esser: Microbial Sciences, BioPharmaceuticals R&D, AstraZeneca
Alicia Lacoma: Universitat Autònoma de Barcelona
Cristina Prat-Aymerich: University Medical Center Utrecht, Utrecht University
Antonio Oliver: Servicio de Microbiología, Hospital Universitari Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdISBa)
Samir Kumar-Singh: University of Antwerp
Surbhi Malhotra-Kumar: University of Antwerp
R. Craig MacLean: University of Oxford, Department of Biology

Nature Communications, 2022, vol. 13, issue 1, 1-11

Abstract: Abstract Bacteria have the potential to translocate between sites in the human body, but the dynamics and consequences of within-host bacterial migration remain poorly understood. Here we investigate the link between gut and lung Pseudomonas aeruginosa populations in an intensively sampled ICU patient using a combination of genomics, isolate phenotyping, host immunity profiling, and clinical data. Crucially, we show that lung colonization in the ICU was driven by the translocation of P. aeruginosa from the gut. Meropenem treatment for a suspected urinary tract infection selected for elevated resistance in both the gut and lung. However, resistance was driven by parallel evolution in the gut and lung coupled with organ specific selective pressures, and translocation had only a minor impact on AMR. These findings suggest that reducing intestinal colonization of Pseudomonas may be an effective way to prevent lung infections in critically ill patients.

Date: 2022
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DOI: 10.1038/s41467-022-34101-2

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