Original Article|Articles in Press

Airway bacterial community composition in persons with advanced cystic fibrosis lung disease

Published:January 09, 2023DOI:


      • Although the progression of lung disease in CF has been associated with airway microbial communities with decreased bacterial diversity, a significant minority of individuals with advanced lung disease maintain relatively diverse communities, and these individuals experience greater lung transplant-free survival.
      • Elucidation of the relationship between lung disease and airway bacterial community structure has potential to advance novel strategies to improve clinical outcomes.



      The progression of lung disease in people with cystic fibrosis (pwCF) has been associated with a decrease in the diversity of airway bacterial communities. How often low diversity communities occur in advanced CF lung disease and how they may be associated with clinical outcomes is not clear, however.


      We sequenced a region of the bacterial 16S ribosomal RNA gene to characterize bacterial communities in sputum from 190 pwCF with advanced lung disease (FEV1≤40% predicted), with particular attention to the prevalence and relative abundance of dominant genera. We evaluated relationships between community diversity and clinical outcomes.


      Although most of the 190 pwCF with advanced lung disease had airway bacterial communities characterized by low diversity with a dominant genus, a considerable minority (40%) did not. The absence of a dominant genus, presence of methicillin-susceptible Staphylococcus aureus, and greater bacterial richness positively correlated with lung function. Higher relative abundance of the dominant genus and greater antimicrobial use negatively correlated with lung function. PwCF with a low diversity community and dominant genus had reduced lung transplant-free survival compared to those without (median survival of 1.6 vs 2.9 years).


      A considerable proportion of pwCF with advanced lung disease do not have airway bacterial communities characterized by low diversity and a dominant genus and these individuals had better survival. An understanding of the antecedents of low diversity airway communities– and the impact these may have on lung disease trajectory - may provide avenues for improved management strategies.



      16S rRNA (16S ribosomal ribonucleic acid), ASV (amplicon sequence variant), BMI (body mass index), CF (cystic fibrosis), CFTR (cystic fibrosis transmembrane conductance regulator), MRSA (methicillin-resistant Staphylococcus aureus), MSSA (methicillin-sensitive Staphylococcus aureus), pwCF (people with cystic fibrosis), ppFEV1 (percent predicted forced expiratory volume in 1 s)
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