Cirrhotics have a high rate of infections, which are increasingly fungal or culture-negative in nature.
While infected cirrhotics have bacterial dysbiosis, the role of fungi is unclear.
Dr Jasmohan Bajaj and colleagues evaluated gut bacterial and fungal dysbiosis in cross-sectional and longitudinal analyses of outpatient and inpatient cirrhotics and prediction of hospitalizations.
Age-matched controls, outpatients and hospitalized uninfected, culture-negative and culture-positive cirrhotics were included and followed for 90 days.
The team categorized 3 studies including cirrhotics followed over 6 months, outpatient cirrhotics administered antibiotics per standard of care for 5 days and cirrhotics and controls administered omeprazole over 14 days.
In all studies, stool bacterial/fungal profiles were analyzed.
|21% were admitted on 90-day follow-up|
The team found that in 143 cirrhotics and 26 controls, bacterial and fungal diversities were significantly linked.
The researchers observed that outpatients on antibiotics and patients with culture-positive infections had the lowest diversities.
Bacterial and fungal correlations were complex in uninfected, outpatient and control groups but were markedly skewed in infected patients.
The team noted that 21% were admitted on 90-day follow-up.
A lower Bacteroidetes/Ascomycota ratio was associated with lower hospitalizations.
The team found that fungal and bacterial profiles were stable on follow-up.
After antibiotics, a significantly reduced bacterial and fungal diversity, higher Candida and lower autochthonous bacterial relative abundance were seen.
After omeprazole, changes in bacterial diversity and composition were seen but fungal metrics remained stable.
Dr Bajaj's team comments, "There is a significant fungal dysbiosis in cirrhosis, which changes differentially with antibiotics and proton pump inhibitor use, but is otherwise stable over time."
"A combined bacterial–fungal dysbiosis metric, Bacteroidetes/Ascomycota ratio, can independently predict 90-day hospitalizations in patients with cirrhosis."