Pathophysiological insights of the role of respiratory dysbiosis in hospital acquired pneumonia
Hospital-acquired pneumonia (HAP) is a major cause of morbidity and mortality. The incidence of HAP remains high, whereas treatment failures are common. Here we review the available data and unanswered questions surrounding HAP, discuss the alterations of the respiratory microbiome and of the mucosal immunity in hospitalized patients, and explore potential approaches to stratify patients for tailored treatments. Lungs have been considered as a sterile organ for decades because microbiological culture techniques reported negative results. Recently, culture-independent techniques have demonstrated that healthy lungs harbour a diverse and dynamic ecosystem of bacteria, changing our comprehension of the respiratory physiopathology. Understanding the respiratory dysbiosis between respiratory microbiome and altered mucosal immunity in critically ill patients holds great promise to develop targeted host-directed immunotherapy to reduce the rate of treatment failure, to improve patient outcomes and to solve the worldwide medical concern of resistant bacteria that are frequently responsible for these infections.
Host: Marc Bonten