Microbiota in patients with cefuroxime resistance and anal fistula revealed by 16S ribosomal DNA

Abstract

BACKGROUND Anal fistula is increasingly prevalent due to modern lifestyle factors, and surgery remains the primary treatment. However, the rising incidence of antibiotic resistance, particularly to cefuroxime, complicates perioperative management. The role of gut microbiota in influencing this resistance is not well understood. AIM To investigate the relationship between gut microbiota composition and cefuroxime resistance in anal fistula patients and to assess probiotic intervention impact. METHODS This study included 30 anal fistula patients categorized into cefuroxime-sensitive (Cefur-S) and cefuroxime-resistant (Cefur-NS) groups. Gut microbiota samples were collected during colonoscopy, and 16S ribosomal DNA sequencing was performed to analyze microbial diversity. Patients in the Cefur-NS group received a 7-day course of Clostridium butyricum tablets. Post-intervention, microbial composition and cefuroxime resistance were reassessed. RESULTS Alpha and beta diversity analyses showed no significant differences in microbial diversity between the Cefur-S and Cefur-NS groups. However, effect size analysis identified Roseburia and Butyricicoccus as dominant genera in the Cefur-S group, with higher butyrate production potentially protecting against cefuroxime resistance. Post-intervention, the Cefur-NS group showed a significant reduction in cefuroxime resistance, improved stool consistency, and reduced bowel movement frequency. CONCLUSION This study suggests that specific gut microbiota, particularly Butyricicoccus and Roseburia , may mitigate cefuroxime resistance in anal fistula patients by increasing butyrate production. Probiotic intervention targeting gut microbiota composition presents a promising strategy for reducing antibiotic resistance and improving clinical outcomes.