TNF and acute respiratory distress syndrome: Various studies have shown that patients with CAP often exhibit reduced microbial diversity, increased bacterial load, and overgrowth of potential pathogenic bacteria.9 Several investigations into CAP patients via 16S ribosomal RNA (rRNA) gene sequencing of sputum samples have indicated that Veillonella and Streptococcus are the most abundant taxa.9,10 In patients with sepsis and acute respiratory distress syndrome (ARDS), the lung microbiome is enriched with gut-associated bacteria and is significantly correlated with alveolar TNF-α,11 a key mediator of alveolar inflammation in ARDS.