Respiratory failure & ventilation
Analysis of the pulmonary microbiome in acute respiratory distress syndrome (ARDS) patients using bronchoalveolar lavage fluid metagenomic next-generation sequencing: a retrospective observational study
Authors' conclusion
The hyperinflammatory phenotype of ARDS is characterized by greater clinical severity and a distinct pulmonary microbiome signature.
Study context
- Population
- ARDS patients with bronchoalveolar lavage fluid (BALF) analysed by metagenomic next-generation sequencing (mNGS) and conventional microbiological testing
- Participants
- 159 patients
- Exposure
- Hyperinflammatory vs hypoinflammatory ARDS subphenotype
- Hyperinflammatoryn = 67
- Hypoinflammatoryn = 92reference
- Outcome
- Pulmonary microbiome species richness
Main finding
As reported in the abstract
- Species richness significantly reduced in hyperinflammatory phenotype (Chao1)
- P < 0.001
- Species richness significantly reduced in hyperinflammatory phenotype (ACE)
- P = 0.001
- Fully adjusted model (age, sex, immunosuppression, ARDS etiology, pulmonary vs extrapulmonary), Chao1
- P = 0.002
- Fully adjusted model, ACE
- P = 0.003
- Overall community structure (β-diversity; PERMANOVA) did not differ
- P = 0.156
Observational data: associations, not effects.
Further findings
In-hospital mortality
P < 0.001
28-day mortality
P < 0.001
Pathogen detection, mNGS vs conventional microbiological testing (CMT)
- mNGS identified pathogens in CMT-negative cases
- 18.2%
- CMT alone detected pathogens in mNGS-negative cases
- 2.5%
- Viral detection, mNGS vs CMT (74.5% vs 28.2%)
- P < 0.001
- Mixed infections identified, mNGS vs CMT (74.5% vs 41.1%)
- P < 0.001
Pathogen profiles by phenotype
- Acinetobacter baumannii most prevalent in both phenotypes; hyperinflammatory enriched for Klebsiella pneumoniae, Legionella pneumophila, influenza A (H1N1); Stenotrophomonas maltophilia and herpesviruses more prevalent in hypoinflammatory
Differentially abundant taxa (LEfSe)
- Hyperinflammatory enriched for Bifidobacterium dentium and Gemella sanguinis; hypoinflammatory enriched for commensals such as Streptococcus mitis
- Exploratory significance
Original publication
Analysis of the pulmonary microbiome in ARDS patients using bronchoalveolar lavage fluid metagenomic next-generation sequencing: a retrospective observational study. J Intensive Care. Published 8 September 2026. doi:10.
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