{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T06:07:08Z","timestamp":1789020428196,"version":"build-2803163510"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize the metagenomic landscape of intra-abdominal pus from surgical ICU patients using metagenomic next-generation sequencing (mNGS), compare pathogen ecology and resistance gene profiles between acute pancreatitis (AP)-associated and non-pancreatitis abdominal infection, and examine the association between pancreatitis-associated microbial features and persistent organ failure status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 115 patients undergoing abdominal paracentesis and drainage in a surgical ICU were stratified into three groups: the POF group (AP with persistent organ failure,\n                      <jats:italic>n<\/jats:italic>\n                      = 35), the Non-POF group (AP without persistent organ failure,\n                      <jats:italic>n<\/jats:italic>\n                      = 49), and the Non-AP group (non-pancreatitis intra-abdominal infection,\n                      <jats:italic>n<\/jats:italic>\n                      = 31). Pus samples were analyzed by mNGS to characterize pathogen profiles, antimicrobial resistance gene (ARG) carriage, and microbial community structure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared with Non-AP infections, both AP groups showed a convergent microbial profile dominated by ICU-associated pathogens, including\n                      <jats:italic>Enterococcus faecium<\/jats:italic>\n                      ,\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      ,\n                      <jats:italic>Acinetobacter baumannii<\/jats:italic>\n                      complex, and\n                      <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                      , with broad ARG detection profiles. ARG positivity was higher in AP patients than Non-AP controls (69.0% vs. 45.2%;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.029), with frequent detection of Beta-lactam resistance genes, including carbapenemase-related genes. At sampling, alpha and beta diversity did not differ between POF and Non-POF groups, whereas both AP groups were clearly separated from Non-AP infections (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.01). Among species enriched in Non-AP pus,\n                      <jats:italic>Enterococcus faecalis<\/jats:italic>\n                      remained inversely associated with AP status after adjustment for comorbidity burden, disease severity, antibiotic exposure, and ICU exposure (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2264 0.006). The family-level random forest model achieved exploratory discriminatory performance for AP identification (AUC = 0.843).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>AP-associated peripancreatic pus harbored a distinct microbial ecological profile characterized by reduced community diversity, predominance of ICU-associated pathogens, and broad ARG detection profiles. This pattern was associated with AP status but not with POF at sampling. These findings may complement antimicrobial risk assessment and empirical treatment decisions when interpreted alongside culture-based susceptibility testing and clinical factors, but require validation in prospective multicenter studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmicb.2026.1950013","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:33:39Z","timestamp":1789018419000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Metagenomic landscape of peripancreatic necrotic pus in acute pancreatitis: pathogen ecology, resistance gene profiles, and disease-associated microbial patterns"],"prefix":"10.3389","volume":"17","author":[{"given":"Haichao","family":"Li","sequence":"first","affiliation":[{"name":"Department of General Surgery, Xuanwu Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenzhen","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Dinfectome Inc., Nanjing","place":["Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruoxi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Xuanwu Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinwei","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Xuanwu Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Li","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Xuanwu Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dachuan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Xuanwu Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1689728","DOI":"10.3389\/fcimb.2025.1689728","article-title":"Infected necrotizing pancreatitis: Clinical features, microbial patterns, and outcomes in a Saudi tertiary center.","volume":"15","author":"Abulfaraj","year":"2025","journal-title":"Front. Cell. Infect. Microbiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1016\/j.cmet.2017.02.007","article-title":"Orai1-mediated antimicrobial secretion from pancreatic acini shapes the gut microbiome and regulates gut innate immunity.","volume":"25","author":"Ahuja","year":"2017","journal-title":"Cell. Metab"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1007\/s10620-025-09474-1","article-title":"Diagnostic performance of metagenomic next-generation sequencing (mNGS) and culture in infected pancreatic necrosis: A systematic review and meta-analysis.","volume":"71","author":"Ali","year":"2026","journal-title":"Dig. Dis. Sci"},{"key":"B4","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1097\/00006676-200303000-00006","article-title":"Role of the gut in the course of severe acute pancreatitis.","volume":"26","author":"Ammori","year":"2003","journal-title":"Pancreas"},{"key":"B5","doi-asserted-by":"publisher","first-page":"67e","DOI":"10.1053\/j.gastro.2019.07.064","article-title":"American gastroenterological association clinical practice update: Management of pancreatic necrosis.","volume":"158","author":"Baron","year":"2020","journal-title":"Gastroenterology"},{"key":"B6","doi-asserted-by":"publisher","first-page":"108501","DOI":"10.1016\/j.ijid.2026.108501","article-title":"Microbiological landscape in critical care: 14-year analysis of 42,722 ICU patients using MIMIC-IV database.","volume":"166","author":"Biswas","year":"2026","journal-title":"Int. J. Infect. Dis"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1703","DOI":"10.1007\/s00134-019-05819-3","article-title":"Epidemiology of intra-abdominal infection and sepsis in critically ill patients: \u2018AbSeS\u2019, a multinational observational cohort study and ESICM trials group project.","volume":"45","author":"Blot","year":"2019","journal-title":"Intensive. Care Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1097\/00000658-200011000-00001","article-title":"Acute necrotizing pancreatitis: Treatment strategy according to the status of infection.","volume":"232","author":"B\u00fcchler","year":"2000","journal-title":"Ann. Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1616215","DOI":"10.3389\/fpubh.2025.1616215","article-title":"Comparative analysis of trends in the burden of pancreatitis in China and worldwide, 1990-2021.","volume":"13","author":"Cai","year":"2025","journal-title":"Front. Public Health"},{"key":"B10","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1016\/j.clnu.2025.06.008","article-title":"The intricate interplay between acute pancreatitis and small intestinal bacterial overgrowth: Unraveling the unknown.","volume":"51","author":"Cui","year":"2025","journal-title":"Clin. Nutr"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1355","DOI":"10.1136\/gutjnl-2022-327448","article-title":"Activated regulatory T-cells promote duodenal bacterial translocation into necrotic areas in severe acute pancreatitis.","volume":"72","author":"Glaubitz","year":"2023","journal-title":"Gut"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e00726","DOI":"10.14309\/ctg.0000000000000726","article-title":"Metagenomic next-generation sequencing-based fine-needle aspiration in patients with suspected infected pancreatic necrosis.","volume":"15","author":"Hong","year":"2024","journal-title":"Clin. Transl. Gastroenterol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1186\/s12879-022-07662-2","article-title":"Plasma metagenomic next-generation sequencing of microbial cell-free DNA detects pathogens in patients with suspected infected pancreatic necrosis.","volume":"22","author":"Hong","year":"2022","journal-title":"BMC Infect. Dis"},{"key":"B14","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1186\/s13099-025-00752-x","article-title":"Exploring the role of gut microbiota in inflammatory bowel disease patients comorbid with non-alcoholic fatty liver disease.","volume":"17","author":"Hu","year":"2025","journal-title":"Gut. Pathog"},{"key":"B15","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1016\/j.pan.2025.04.020","article-title":"International association of Pancreatology revised guidelines on acute pancreatitis 2025: Supported and endorsed by the American pancreatic association, European pancreatic club, Indian pancreas club, and Japan pancreas society.","volume":"25","year":"2025","journal-title":"Pancreatology"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1717419","DOI":"10.3389\/fcimb.2026.1717419","article-title":"Risk factors for carbapenem-resistant Klebsiella pneumoniae infection in hospitalized patients: A meta-analysis.","volume":"16","author":"Jin","year":"2026","journal-title":"Front. Cell. Infect. Microbiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"2187","DOI":"10.3748\/wjg.v26.i18.2187","article-title":"Role of gut microbiota on intestinal barrier function in acute pancreatitis.","volume":"26","author":"Li","year":"2020","journal-title":"World J. Gastroenterol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"435","DOI":"10.3390\/diagnostics15040435","article-title":"Predictive value of several parameters for severity of acute pancreatitis in a cohort of 172 patients.","volume":"15","author":"Li\u0163\u00e3 Cofaru","year":"2025","journal-title":"Diagnostics."},{"key":"B19","doi-asserted-by":"publisher","first-page":"2328","DOI":"10.1007\/s10620-025-08996-y","article-title":"The global, regional, and national burden of pancreatitis in 204 countries and territories, 1990-2021: A systematic analysis for the global burden of disease study 2021.","volume":"70","author":"Liu","year":"2025","journal-title":"Dig. Dis. Sci"},{"key":"B20","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1038\/s41522-024-00499-4","article-title":"Integrative metagenomic and metabolomic analyses reveal the potential of gut microbiota to exacerbate acute pancreatitis.","volume":"10","author":"Liu","year":"2024","journal-title":"NPJ Biofilms Microbiomes"},{"key":"B21","doi-asserted-by":"publisher","first-page":"6889","DOI":"10.2147\/IDR.S573970","article-title":"Distribution features and antimicrobial resistance trends of clinical pathogens: A retrospective study in a tertiary teaching hospital in east China (2020-2024).","volume":"18","author":"Liu","year":"2025","journal-title":"Infect. Drug Resist"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.1038\/s41564-026-02351-1","article-title":"Sulfated bile acid produced by a human gut commensal alleviates paediatric sepsis in mice.","volume":"11","author":"Liu","year":"2026","journal-title":"Nat. Microbiol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"106618","DOI":"10.1016\/j.jinf.2025.106618","article-title":"Bacteriophage combined with mNGS enhances the specificity of bacterial infection diagnosis.","volume":"91","author":"Liu","year":"2025","journal-title":"J. Infect"},{"key":"B24","doi-asserted-by":"publisher","first-page":"108412","DOI":"10.1016\/j.micpath.2026.108412","article-title":"Global strategies to fight carbapenem-resistant Acinetobacter baumannii (CRAB) infections.","volume":"214","author":"Makwana","year":"2026","journal-title":"Microb. Pathog"},{"key":"B25","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1038\/ncpgasthep0293","article-title":"Current management of acute pancreatitis.","volume":"2","author":"Mayerle","year":"2005","journal-title":"Nat. Clin. Pract. Gastroenterol. Hepatol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.sopen.2024.03.012","article-title":"Predicting the severity of acute pancreatitis: Current approaches and future directions.","volume":"19","author":"Metri","year":"2024","journal-title":"Surg. Open Sci"},{"key":"B27","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1046\/j.1523-1755.2000.00882.x","article-title":"Clonal spread of staphylococci among patients with peritonitis associated with continuous ambulatory peritoneal dialysis.","volume":"57","author":"Monsen","year":"2000","journal-title":"Kidney Int"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1274","DOI":"10.1186\/s12879-026-13572-4","article-title":"Clinical outcomes and mortality in carbapenem-resistant versus susceptible Klebsiella pneumoniae bloodstream infections in intensive care units.","volume":"26","author":"\u00d6z\u00e7elik","year":"2026","journal-title":"BMC Infect. Dis."},{"key":"B29","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s13054-023-04780-4","article-title":"Gut mycobiome dysbiosis after sepsis and trauma.","volume":"28","author":"Park","year":"2024","journal-title":"Crit. Care"},{"key":"B30","doi-asserted-by":"publisher","first-page":"dkag092","DOI":"10.1093\/jac\/dkag092","article-title":"Antimicrobial therapy for infected necrotizing pancreatitis: Microbiology, antimicrobial resistance and pharmacokinetics.","volume":"81","author":"Pauw","year":"2026","journal-title":"J. Antimicrob. Chemother"},{"key":"B31","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1097\/SLA.0b013e31815b6976","article-title":"Debridement and closed packing for sterile or infected necrotizing pancreatitis: Insights into indications and outcomes in 167 patients.","volume":"247","author":"Rodriguez","year":"2008","journal-title":"Ann. Surg"},{"key":"B32","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1186\/s13756-020-00871-x","article-title":"Infections and antimicrobial resistance in intensive care units in lower-middle income countries: A scoping review.","volume":"10","author":"Saharman","year":"2021","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e70342","DOI":"10.1111\/ped.70342","article-title":"Clinical characteristics of pediatric Moraxella bacteremia in a children\u2019s hospital.","volume":"68","author":"Shin","year":"2026","journal-title":"Pediatr. Int"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1145","DOI":"10.3233\/SHTI251018","article-title":"Unraveling the role of gut microbiota in colorectal cancer: A global perspectives and biomarkers as early screening tool for colorectal cancer.","volume":"329","author":"Upadhyay","year":"2025","journal-title":"Stud. Health Technol. Inform"},{"key":"B35","doi-asserted-by":"publisher","first-page":"502456","DOI":"10.1016\/j.gastrohep.2025.502456","article-title":"The diagnostic efficacy of metagenomic next-generation sequencing in spontaneous bacterial peritonitis: System review and meta-analysis.","volume":"48","author":"Wang","year":"2025","journal-title":"Gastroenterol. Hepatol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"943","DOI":"10.3760\/cma.j.cn121430-20200417-00312","article-title":"[Clinical analysis of septic shock caused by acute upper and lower gastrointestinal perforation].","volume":"32","author":"Wang","year":"2020","journal-title":"Zhonghua Wei Zhong Bing Ji. Jiu Yi Xue"},{"key":"B37","doi-asserted-by":"publisher","first-page":"114769","DOI":"10.1016\/j.biopha.2023.114769","article-title":"Lactulose regulates gut microbiota dysbiosis and promotes short-chain fatty acids production in acute pancreatitis patients with intestinal dysfunction.","volume":"163","author":"Wang","year":"2023","journal-title":"Biomed. Pharmacother"},{"key":"B38","doi-asserted-by":"publisher","first-page":"17308","DOI":"10.1038\/s41598-025-02543-5","article-title":"Distribution and drug resistance analysis of pathogens in early-stage digestive tract perforation complicated with peritonitis.","volume":"15","author":"Wang","year":"2025","journal-title":"Sci. Rep"},{"key":"B39","doi-asserted-by":"publisher","first-page":"17562848231202133","DOI":"10.1177\/17562848231202133","article-title":"Gut microbiota interacts with inflammatory responses in acute pancreatitis.","volume":"16","author":"Wu","year":"2023","journal-title":"Ther. Adv. Gastroenterol"},{"key":"B40","doi-asserted-by":"publisher","first-page":"2489768","DOI":"10.1080\/19490976.2025.2489768","article-title":"Exploring the mechanism of intestinal bacterial translocation after severe acute pancreatitis: The role of Toll-like receptor 5.","volume":"17","author":"Zhang","year":"2025","journal-title":"Gut. Microbes"},{"key":"B41","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1007\/s00535-018-1529-0","article-title":"Gut microbiota dysbiosis worsens the severity of acute pancreatitis in patients and mice.","volume":"54","author":"Zhu","year":"2019","journal-title":"J. Gastroenterol"}],"container-title":["Frontiers in Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2026.1950013\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:33:41Z","timestamp":1789018421000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2026.1950013\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,10]]},"references-count":41,"alternative-id":["10.3389\/fmicb.2026.1950013"],"URL":"https:\/\/doi.org\/10.3389\/fmicb.2026.1950013","relation":{},"ISSN":["1664-302X"],"issn-type":[{"value":"1664-302X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,10]]},"article-number":"1950013"}}