Dysbiosis and Staphylococcus species over representation in the exit site skin microbiota of hemodialysis patients carrying tunneled cuffed central venous catheter

Abstract

Objectives

Hemodialysis patients with end-stage renal disease (ESRD) are susceptible to infections and dysbiosis. Catheter-related infections are typically caused by opportunistic skin pathogens. This study aims to compare the skin microbiota changes around the exit site of tunneled cuffed catheters (peri-catheter group) and the contralateral site (control group).

Methods

ESRD patients on hemodialysis were recruited. The skin microbiota were collected with moist skin swabs and analyzed using high-throughput sequencing of the 16S rDNA V3–V4 region. After denoising, de-replication, and removal of chimeras, the reads were assigned to zero-radius operational taxonomic units (ZOTU).

Results

We found significantly reduced alpha diversity in the peri-catheter group compared to the control group, as indicated by the Shannon, Jost, and equitability indexes, but not by the Chao1 or richness indexes. Beta diversity analysis revealed significant deviation of the peri-catheter microbiota from its corresponding control group. There was an overrepresentation of Firmicutes and an underrepresentation of Actinobacteria, Proteobacteria, and Acidobacteria at the phylum level in the peri-catheter group. The most abundant ZOTU (Staphylococcus spp.) drastically increased, while Cutibacterium, a commensal bacterium, decreased in the peri-catheter group. Network analysis revealed that the skin microbiota demonstrated covariance with both local and biochemical factors.

Conclusions

In conclusion, there was significant skin microbiota dysbiosis at the exit sites compared to the control sites in ESRD dialysis patients. Managing skin dysbiosis represents a promising target in the prevention of catheter-related bacterial infections.

Keywords:

• Hemodialysis
• skin microbiota
• metagenome
• tunneled cuffed catheters
• dysbiosis

Acknowledgments

The authors thank all the patients for participating in this study and providing samples.

Author contributions

BX and ML designed this project. BX recruited the subjects, collected the clinical data, and obtained the microbiota specimens. ML conducted the bioinformatic analysis. BX and XH performed the statistical analysis. BX and ML coauthored the manuscript. All researchers read and approved the final draft that was submitted.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The sequencing data generated for this study can be found in the National Center for Biotechnology Information (NCBI) database, with the accession code PRJNA1061650. The sequence data is publicly available.

Additional information

Funding

This work was supported by the National Science Foundation of China under Grant No. 82370536 and the Natural Science Foundation of Shandong Province under Grant No. ZR2022MH098.