Microbiota analysis in the hemodialysis population — Focusing on Enterobacteriaceae

<p><strong>Abstract</strong></p> <p><strong>Background: </strong><br> Infection is a recognized risk factor for mortality among hemodialysis patients, including infection caused by <em>Enterobacteriaceae</em>. We aimed to investigate <em>Enterobacteriaceae</em> in gut microbiota among hemodialysis patients and to analyze associations between microbiota and clinical parameters</p> <p><strong>Materials and Methods</strong>:<br> This prospective study of microbiota analysis in hemodialysis patients was conducted in April-May 2018. A control group without recent antibiotic use or hospitalization was used for comparison. Stool samples underwent 16S rRNA sequencing, using Greengenes 16S rRNA database for microbiota analysis.</p> <p><strong>Results:</strong><br> Among 96 hemodialysis (HD) patients, mean age was 61.9&plusmn;0.8 years and mean duration of HDwas 6.5&plusmn;0.7 years. No significant differences were found in alpha diversity between HD and control groups (HD group 949.5, controls 898; p=0.16) although significant between-group differences were found in beta diversity(P&lt;0.001). At phylum level, HD group hada higher abundance of <em>Firmicutes</em> (median 0.58 [0.1-0.96] vs. 0.53 [0.09-0.88]; p= 0.034) and <em>Proteobacteria</em> (median 0.06 [0-0.68] vs. 0.02 [0-0.68]; p=0.005), but lower abundance of <em>Bacteriodetes</em> (median 0.12 [0.002-0.63] vs. 0.29 [0.002-0.82];p=0.001). At genus level, the five most frequentoperational taxonomic unit (OTU) IDs were <em>Escherichia-Shigella</em> complex (3), <em>Escherichia</em> and <em>Klebsiella</em>.&nbsp;</p> <p><strong>Conclusions:</strong></p> <p>Alpha diversity in HD patients is not lower than that in healthy controls but significant between-group differences are found in microbiota composition according to beta diversity, due to decreased <em>Bacteriodetes</em>and increased <em>Firmicutes</em> and<em> Proteobacteria. </em>HD patients have a higher abundance of <em>Proteobacteria </em>in spite of reserved diversity, but without correlation with clinical factors.</p>