Clinical impact of altered gut microbiota and metabolite profiles on mortality in patients with candidemia: A prospective observation pilot study

Background The gut microbiota plays an important role in defense against infectious diseases. However, data on clinical effects of microbiome profiles in patients with candidemia are limited. This study investigated the intestinal microbiome and the effects on mortality in patients with candidemia. Methods In this prospective observational pilot study, fecal samples from adult patients with candidemia were subjected to 16S rRNA gene sequencing for microbiota analysis and gas chromatography–mass spectrometry metabolomics. Multivariate logistic regression was conducted to identify predictors of in-hospital mortality. Results Fifty-nine patients with candidemia were analyzed, with an in-hospital mortality rate of 40.7%. The median Shannon’s diversity index of the gut microbiota was significantly lower in survivors than in non-survivors ( P  = 0.009). Linear discriminant analysis Effect Size revealed 11 bacterial species that significantly differed between the two groups. Among 111 fecal metabolites, only 3-isopropoxy-hexamethyl-tetrasiloxane was differentially expressed between survivors and non-survivors ( P  = 0.007). Septic shock (adjusted odds ratio: 10.59; 95% confidence interval, 1.70–65.97), underlying malignancy (7.79 [1.41–43.10]), and Shannon’s diversity index (0.40 [0.19–0.84]) were significant predictors of in-hospital mortality. Conclusion Low gut bacterial diversity was independently associated with increased mortality in patients with candidemia. The intestinal microbiome could offer new perspectives for the prevention and the treatment of candidemia.