Intensive Care Medicine Experimental (Dec 2020)

Endotoxemia and circulating bacteriome in severe COVID-19 patients

  • Phatadon Sirivongrangson,
  • Win Kulvichit,
  • Sunchai Payungporn,
  • Trairak Pisitkun,
  • Ariya Chindamporn,
  • Sadudee Peerapornratana,
  • Prapaporn Pisitkun,
  • Suwalak Chitcharoen,
  • Vorthon Sawaswong,
  • Navaporn Worasilchai,
  • Sarinya Kampunya,
  • Opass Putcharoen,
  • Thammasak Thawitsri,
  • Nophol Leelayuwatanakul,
  • Napplika Kongpolprom,
  • Vorakamol Phoophiboon,
  • Thitiwat Sriprasart,
  • Rujipat Samransamruajkit,
  • Somkanya Tungsanga,
  • Kanitha Tiankanon,
  • Nuttha Lumlertgul,
  • Asada Leelahavanichkul,
  • Tueboon Sriphojanart,
  • Terapong Tantawichien,
  • Usa Thisyakorn,
  • Chintana Chirathaworn,
  • Kearkiat Praditpornsilpa,
  • Kriang Tungsanga,
  • Somchai Eiam-Ong,
  • Visith Sitprija,
  • John A. Kellum,
  • Nattachai Srisawat

DOI
https://doi.org/10.1186/s40635-020-00362-8
Journal volume & issue
Vol. 8, no. 1
pp. 1 – 15

Abstract

Read online

Abstract Background When severe, COVID-19 shares many clinical features with bacterial sepsis. Yet, secondary bacterial infection is uncommon. However, as epithelium is injured and barrier function is lost, bacterial products entering the circulation might contribute to the pathophysiology of COVID-19. Methods We studied 19 adults, severely ill patients with COVID-19 infection, who were admitted to King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between 13th March and 17th April 2020. Blood samples on days 1, 3, and 7 of enrollment were analyzed for endotoxin activity assay (EAA), (1 → 3)-β-d-glucan (BG), and 16S rRNA gene sequencing to determine the circulating bacteriome. Results Of the 19 patients, 13 were in intensive care and 10 patients received mechanical ventilation. We found 8 patients with high EAA (≥ 0.6) and about half of the patients had high serum BG levels which tended to be higher in later in the illness. Although only 1 patient had a positive blood culture, 18 of 19 patients were positive for 16S rRNA gene amplification. Proteobacteria was the most abundant phylum. The diversity of bacterial genera was decreased overtime. Conclusions Bacterial DNA and toxins were discovered in virtually all severely ill COVID-19 pneumonia patients. This raises a previously unrecognized concern for significant contribution of bacterial products in the pathogenesis of this disease.

Keywords