Each Additional Day of Antibiotics Is Associated With Lower Gut Anaerobes in Neonatal Intensive Care Unit Patients

Abstract

Background Discontinuation of inappropriate antimicrobial therapy is an important target for stewardship intervention. The drug and duration-dependent effects of antibiotics on the developing neonatal gut microbiota needs to be precisely quantified. Methods In this retrospective, cross-sectional study, we performed 16S rRNA sequencing on stool swab samples collected from neonatal intensive care unit patients within 7 days of discontinuation of therapy who received ampicillin and tobramycin (AT), ampicillin and cefotaxime (AC), or ampicillin, tobramycin, and metronidazole (ATM). We compared taxonomic composition within term and preterm infant groups between treatment regimens. We calculated adjusted effect estimates for antibiotic type and duration of therapy on the richness of obligate anaerobes and known butyrate-producers in all infants. Results A total of 72 infants were included in the study. Term infants received AT (20/28; 71%) or AC (8/28; 29%) with median durations of 3 and 3.5 days, respectively. Preterm infants received AT (32/44; 73%) or ATM (12/44; 27%) with median durations of 4 and 7 days, respectively. Compositional analyses of 67 stool swab samples demonstrated low diversity and dominance by potential pathogens. Within 1 week of discontinuation of therapy, each additional day of antibiotics was associated with lower richness of obligate anaerobes (adjusted risk ratio [aRR], 0.84; 95% confidence interval [CI], .73–.95) and butyrate-producers (aRR, 0.82; 95% CI, .67–.97). Conclusions Each additional day of antibiotics was associated with lower richness of anaerobes and butyrate-producers within 1 week after therapy. A longitudinally sampled cohort with preexposure sampling is needed to validate our results.

Antibiotic Exposure Prevents Acquisition of Beneficial Metabolic Functions in the Preterm Infant Gut Microbiome

“…Exposure to antibiotics appears to alter the developmental trajectory. In agreement with previous reports [9][10][11][12][13] and contrary to others [14][15][16], gestational age at birth appeared to exert less in uence on the microbiota development than postnatal age. In our study, both gestational age and postnatal age independently exerted effects on the preterm infant microbiome.…”

The Diversity of the Intestinal Flora Disturbed After Feeding Intolerance Recovery in Preterm Twins

“…Whether gestational age is an important factor that affects the composition of the intestinal flora after FI is cured is not clear, which need a larger sample to conclude. Previous studies have pointed out that the empirical use of antibiotics (including antenatal antibiotics and postnatal antibiotics) can lead to an decrease in Alpha diversity, delayed colonization of anaerobic bacteria, and the impact of antibiotics on the intestinal flora can last several months after the drug was stopped ( 33 , 34 ). The pre-and post-natal antibiotics used in our study were Piperacillin/cephalosporin.…”

Establishing the role of the gut microbiota in susceptibility to recurrent urinary tract infections

“…Concurrently, the gut-bladder axis highlights a further limitation of existing antibiotic treatments. Not only is antibiotic treatment a known risk factor for rUTI, antibiotics can cause significant and long-lasting perturbations of the gut microbiome ( 27 , 28 ). If indeed UTI antibiotics generate, or maintain, a state of gut dysbiosis, this represents a vicious circle of treatment enhancing susceptibility to future infection.…”