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Natl. Acad. Sci. U.S.A."],"published-print":{"date-parts":[[2026,4,28]]},"abstract":"<jats:p>\n                    Broad-spectrum antibiotics are frequently administered to intensive care unit patients as part of empiric care. This treatment has been associated with subsequent infections by the emerging nosocomial pathogen\n                    <jats:italic toggle=\"yes\">\n                      <jats:italic toggle=\"yes\">Acinetobacter<\/jats:italic>\n                      baumannii\n                    <\/jats:italic>\n                    ; however, the mechanisms underlying this linkage remain unclear. Here, we observe an association between antibiotic treatment and microbiota disruption that precedes\n                    <jats:italic toggle=\"yes\">A. baumannii<\/jats:italic>\n                    infection in a hospitalized patient cohort and demonstrate in a murine model that broad-spectrum antibiotic administration drives susceptibility to intranasal infection with this pathogen. Reconstitution of the intestinal microbiota by fecal microbiota transplant restores control of\n                    <jats:italic toggle=\"yes\">A. baumannii<\/jats:italic>\n                    bloodstream dissemination, implicating microbiota dysbiosis as a key driver of pulmonary disease. Using single-cell RNA sequencing, we determine that antibiotic pretreatment reduces the abundance of transcripts related to phagocyte effector functions in the lung, including nutritional immunity pathways that restrict pathogen access to essential nutrient metals. Depletion studies identify neutrophils and inflammatory monocytes as central mediators of microbiota-dependent protection, and loss of the nutritional immunity components lipocalin-2 or calprotectin abrogates the effects of antibiotics on infected mice, demonstrating a causal relationship between microbiota dysbiosis and impaired phagocyte-mediated nutritional immunity. Together, these findings provide a mechanism for the increased severity of\n                    <jats:italic toggle=\"yes\">A. baumannii<\/jats:italic>\n                    pneumonia following antibiotic exposure and highlight the intestinal microbiota as a potential therapeutic target to prevent nosocomial infections with this and other healthcare-associated pathogens.\n                  <\/jats:p>","DOI":"10.1073\/pnas.2534432123","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T16:25:41Z","timestamp":1776788741000},"update-policy":"https:\/\/doi.org\/10.1073\/pnas.cm10313","source":"Crossref","is-referenced-by-count":4,"title":["The intestinal microbiota impacts nutritional immunity and resistance to\n                    <i>Acinetobacter baumannii<\/i>\n                    pneumonia"],"prefix":"10.1073","volume":"123","author":[{"given":"Erin R.","family":"Green","sequence":"first","affiliation":[{"name":"Department of Microbiology, University of Chicago","place":["Chicago"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas M.","family":"Negretti","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Vanderbilt University Medical Center","place":["Nashville"]},{"name":"Biodevelopmental Origins of Lung Disease Center, Vanderbilt University School of Medicine","place":["Nashville"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tess H.","family":"Brunner","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University of Chicago","place":["Chicago"]},{"name":"Duchossois Family Institute, University of Chicago","place":["Chicago"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas G.","family":"Shealy","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center","place":["Nashville"]},{"name":"Vanderbilt Institute for Infection, Immunology and Inflammation, Vanderbilt University Medical Center","place":["Nashville"]},{"name":"Division of Protective Immunity, Children\u2019s Hospital of Philadelphia","place":["Philadelphia"]},{"name":"Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania","place":["Philadelphia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe A.","family":"Moser","sequence":"additional","affiliation":[{"name":"Delft Center for Systems and Control, Delft University of Technology, Delft","place":["Zuid-Holland, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sydney L.","family":"Drury","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center","place":["Nashville"]},{"name":"Vanderbilt Institute for Infection, Immunology and Inflammation, Vanderbilt University Medical Center","place":["Nashville"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kacie A.","family":"Traina","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center","place":["Nashville"]},{"name":"Vanderbilt Institute for Infection, Immunology and Inflammation, Vanderbilt University Medical Center","place":["Nashville"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria M.","family":"Reyes Ruiz","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center","place":["Nashville"]},{"name":"Vanderbilt Institute for Infection, Immunology and Inflammation, Vanderbilt University Medical Center","place":["Nashville"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzushan S.","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology and 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Mohd Sazlly Lim , The global prevalence of multidrug-resistance among Acinetobacter baumannii causing hospital-acquired and ventilator-associated pneumonia and its associated mortality: A systematic review and meta-analysis. J. Infect. 79, 593\u2013600 (2019), 10.1016\/j.jinf.2019.09.012.","journal-title":"J. Infect."},{"key":"e_1_3_5_2_2","doi-asserted-by":"crossref","first-page":"2221","DOI":"10.1016\/S0140-6736(22)02185-7","article-title":"Global mortality associated with 33 bacterial pathogens in 2019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"400","author":"GBD 2019 Antimicrobial Resistance Collaborators","year":"2022","unstructured":"GBD 2019 Antimicrobial Resistance Collaborators, Global mortality associated with 33 bacterial pathogens in 2019: A systematic analysis for the Global Burden of Disease Study 2019. 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Cell Host Microbe 30, 975\u2013987.e7 (2022), 10.1016\/j.chom.2022.03.019.","journal-title":"Cell Host Microbe"},{"key":"e_1_3_5_5_2","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1586\/14787210.2015.1025055","article-title":"Community-acquired Acinetobacter baumannii: Clinical characteristics, epidemiology and pathogenesis","volume":"13","author":"Dexter C.","year":"2015","unstructured":"C. Dexter, G. L. Murray, I. T. Paulsen, A. Y. Peleg, Community-acquired Acinetobacter baumannii: Clinical characteristics, epidemiology and pathogenesis. Expert Rev. Anti Infect. Ther. 13, 567\u2013573 (2015), 10.1586\/14787210.2015.1025055.","journal-title":"Expert Rev. Anti Infect. Ther."},{"key":"e_1_3_5_6_2","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1007\/s10096-007-0365-6","article-title":"Community-acquired Acinetobacter infections","volume":"26","author":"Falagas M. E.","year":"2007","unstructured":"M. E. Falagas, E. A. Karveli, I. Kelesidis, T. 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Microbiol."},{"key":"e_1_3_5_10_2","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1017\/S0950268807009478","article-title":"Acinetobacter infections: A growing threat for critically ill patients","volume":"136","author":"Falagas M. E.","year":"2008","unstructured":"M. E. Falagas, E. A. Karveli, I. I. Siempos, K. Z. Vardakas, Acinetobacter infections: A growing threat for critically ill patients. Epidemiol. Infect. 136, 1009\u20131019 (2008), 10.1017\/S0950268807009478.","journal-title":"Epidemiol. Infect."},{"key":"e_1_3_5_11_2","doi-asserted-by":"crossref","first-page":"162","DOI":"10.3390\/antibiotics13020162","article-title":"Practical lessons on antimicrobial therapy for critically Ill patients","volume":"13","author":"Cusack R.","year":"2024","unstructured":"R. Cusack, E. Little, I. Martin-Loeches, Practical lessons on antimicrobial therapy for critically Ill patients. 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Schlechte , Dysbiosis of a microbiota\u2013immune metasystem in critical illness is associated with nosocomial infections. Nat. Med. 29, 1017\u20131027 (2023), 10.1038\/s41591-023-02243-5.","journal-title":"Nat. Med."},{"key":"e_1_3_5_16_2","doi-asserted-by":"crossref","first-page":"eadt1466","DOI":"10.1126\/sciadv.adt1466","article-title":"Fecal metabolite profiling identifies critically ill patients with increased 30-day mortality","volume":"11","author":"de Porto A. P.","year":"2025","unstructured":"A. P. de Porto , Fecal metabolite profiling identifies critically ill patients with increased 30-day mortality. Sci. Adv. 11, eadt1466 (2025), 10.1126\/sciadv.adt1466.","journal-title":"Sci. Adv."},{"key":"e_1_3_5_17_2","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1186\/s13613-024-01407-x","article-title":"Early reduction in gut microbiota diversity in critically ill patients is associated with mortality","volume":"14","author":"Wozniak H.","year":"2024","unstructured":"H. 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