Background Enterococcus intestinal domination (EID), a state of dysbiosis wherein enterococci comprise ≥30% abundance within the microbiota, has been associated with Enterococcus bacteremia, graft-versus-host disease, and mortality in the allogeneic hematopoietic stem cell transplant (allo HCT) population. The acute leukemia (AL) chemotherapy population includes patients receiving intensive chemotherapy but do not all go on to have an allo HCT. The impact of EID on outcomes including mortality in the AL chemotherapy population is unknown. Methods Microbiota composition from weekly stool samples was analyzed by 16S ribosomal RNA gene sequencing. Patients were analyzed in 2 cohorts: AL chemotherapy cohort and allo HCT cohort. Alpha-diversity and richness were calculated. Kaplan Meier Analysis was used to analyze mortality. Results 929 stool samples were collected from 139 patients. Both allo HCT and AL cohorts had a decline in α-diversity and richness over the course of treatment that tends not to return to baseline months later. EID was observed in at least one sample in 36% of allo HCT patients and 49% of AL patients. Patients with observed EID had lower alpha-diversity over time. Similar to the HCT cohort, AL patients with EID had reduced overall survival. We identified 4 other genera that were commonly found in ≥30% relative abundance within the microbiota, but none were associated with mortality. In fact, in allo HCT, Bacteroides abundance ≥30% was associated with improved survival. Conclusions EID is associated with increased all-cause mortality in HCT and AL cohorts. Unlike EID, relative abundance ≥30% by other genera is not associated with increased all-cause mortality.

中文翻译：

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肠球菌肠道控制与急性白血病化疗人群死亡率增加有关

背景 肠球菌肠道优势 (EID) 是一种生态失调状态，其中肠球菌在微生物群中的丰度≥30%，与同种异体造血干细胞移植 (allo HCT) 中的肠球菌菌血症、移植物抗宿主病和死亡率有关人口。急性白血病 (AL) 化疗人群包括接受强化化疗但并非都继续接受同种异体 HCT 的患者。EID 对包括 AL 化疗人群死亡率在内的结果的影响尚不清楚。方法 通过 16S 核糖体 RNA 基因测序分析每周粪便样本中的微生物群组成。患者在 2 个队列中进行了分析：AL 化疗队列和同种异体 HCT 队列。计算了阿尔法多样性和丰富度。Kaplan Meier 分析用于分析死亡率。结果共收集到139例患者粪便样本929份。同种异体 HCT 和 AL 队列在治疗过程中的 α 多样性和丰富度均有所下降，而且往往在几个月后不会恢复到基线水平。在 36% 的同种异体 HCT 患者和 49% 的 AL 患者的至少一个样本中观察到 EID。随着时间的推移，观察到 EID 的患者具有较低的 alpha 多样性。与 HCT 队列相似，患有 EID 的 AL 患者的总生存期降低。我们确定了另外 4 个属，这些属在微生物群中通常具有 ≥ 30% 的相对丰度，但没有一个与死亡率相关。事实上，在同种异体 HCT 中，拟杆菌属丰度≥30% 与生存率提高相关。结论 EID 与 HCT 和 AL 队列中的全因死亡率增加有关。与 EID 不同，