Clinical impact of altered gut microbiota and metabolite profiles on mortality in patients with candidemia: a prospective observational pilot cohort study.

The in-hospital mortality rate among patients with candidemia in this cohort was 40.7%.

• 59 adult patients with culture-confirmed candidemia were analyzed.
• This was a prospective, observational, pilot cohort study.
• Fecal samples were collected within 5 days of diagnosis.
• In-hospital mortality was defined as death during hospitalization.

Gut microbiota diversity was significantly lower in non-survivors than in survivors of candidemia.

• The median Shannon diversity index was significantly lower in non-survivors compared to survivors (P = 0.009).
• Microbiota profiling was performed using 16S ribosomal RNA gene sequencing.
• Fecal samples were collected within 5 days of candidemia diagnosis.

Linear discriminant analysis identified 11 bacterial species that differed significantly between survivors and non-survivors.

• Analysis was conducted using linear discriminant analysis (LDA).
• 11 bacterial species distinguished survivors from non-survivors.
• Microbiota profiling was based on 16S ribosomal RNA gene sequencing of fecal samples.

Among 111 fecal metabolites analyzed, only 3-isopropoxy-hexamethyl-tetrasiloxane differed significantly between survivors and non-survivors.

• 111 fecal metabolites were assessed using gas chromatography-mass spectrometry.
• 3-isopropoxy-hexamethyl-tetrasiloxane was the sole metabolite significantly different between groups (P = 0.007).
• No other metabolites showed statistically significant differences between survivors and non-survivors.

Septic shock, underlying malignancy, and Shannon diversity index were significant independent predictors of in-hospital mortality in multivariate logistic regression.

• Septic shock had an adjusted odds ratio (aOR) of 10.59 (95% CI: 1.70–65.97).
• Underlying malignancy had an aOR of 7.79 (95% CI: 1.41–43.10).
• Shannon diversity index had an aOR of 0.40 (95% CI: 0.19–0.84), indicating that higher diversity was associated with lower mortality.
• Multivariate logistic regression was used to identify these predictors.