Prospective evaluation of effects of broad-spectrum antibiotics on gastrointestinal yeast colonization of humans

Samonis, George; Gikas, Achilleas; Anaissie, Elias; Vrenzos, G; Maraki, Sofia; Tselentis, Yannis; Bodey, Gerald P.

doi:10.1128/aac.37.1.51

Cited by 156 publications

(129 citation statements)

References 24 publications

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“…When broad-spectrum antibiotics are administered, these have the potential to cause serious disruption to the entire bacterial community in the GI tract, perturb the equilibrium and allow the host to become susceptible to infections by normally benign, commensal fungi such as C. albicans (Samonis et al 1993). Antibiotics are, therefore, a major risk factor for candidemia in hospitalized patients (Wey et al 1989, Nucci and Colombo 2002, Zaoutis et al 2010.…”

Section: Cross-kingdom Interactionsmentioning

confidence: 99%

The human gut mycobiome: pitfalls and potentials--a mycologists perspective

2015

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Abstract:We have entered the Age of the Microbiome, with new studies appearing constantly and whole journals devoted to the human microbiome. While bacteria outnumber other gut microbes by orders of magnitude, eukaryotes are consistently found in the human gut and are represented primarily by the fungi. Compiling 36 studies 1917-2015 we found at least 267 distinct fungal taxa have been reported from the human gut, and seemingly every new study includes one or more fungi not previously described from this niche. This diversity, while impressive, is illusory. If we examine gut fungi, we will quickly observe a division between a small number of commonly detected species (Candida yeasts, Saccharomyces and yeasts in the Dipodascaceae, and Malassezia species) and a long tail of taxa that have been reported only once. Furthermore, an investigation into the ecology of these rare species reveals that many of them are incapable of colonization or long-term persistence in the gut. This paper examines what we know and have yet to learn about the fungal component of the gut microbiome, or "mycobiome", and an overview of methods. We address the potential of the field while introducing some caveats and argue for the necessity of including mycologists in mycobiome studies.

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Section: Cross-kingdom Interactionsmentioning

confidence: 99%

The human gut mycobiome: pitfalls and potentials--a mycologists perspective

2015

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“…9,12 Microbiologic analysis Fecal samples of the study patients were monitored twice weekly for growth of aerobic and anaerobic bacteria as well as fungi, using modified microbiologic culture techniques as previously published. 10,12 Quantitative bacterial cultures were taken using a conventional plate counting technique. …”

Section: Supportive Carementioning

confidence: 99%

“…9 After total gut decontamination using metronidazole to reduce intestinal anaerobic microflora, yeast overgrowth is evident. 10 Here, we report our experience on the impact of fungal overgrowth on invasive fungal infections (IFI) in these study patients.…”

mentioning

confidence: 99%

Fungal colonization and invasive fungal infections following allogeneic BMT using metronidazole, ciprofloxacin and fluconazole or ciprofloxacin and fluconazole as intestinal decontamination

Trenschel

Peceny

Runde

et al. 2000

Bone Marrow Transplant

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Summary:Invasive fungal infections (IFI) are increasingly diagnosed in patients undergoing allogeneic BMT. We have previously shown that the addition of metronidazole to ciprofloxacin for gastrointestinal bacterial decontamination significantly reduces the incidence of grades II-IV aGVHD by reduction of the anaerobic intestinal bacterial flora. Here, we found that the combined use of ciprofloxacin, metronidazole and fluconazole as antifungal prophylaxis increased intestinal yeast colonization when compared to ciprofloxacin and fluconazole alone (P Ͻ 0.01). Based on the EORTC criteria, a total of 18 out of 134 study patients developed IFI: seven of 68 (10%) patients who received metronidazole compared to 11 of the 66 (17%) patients decontaminated without metronidazole developed IFI (log-rank P = 0.36). Lethal IFI occurred in two of seven patients receiving metronidazole and in four of 11 patients without anaerobic decontamination. In conclusion, bacterial intestinal decontamination using metronidazole as an antibiotic with activity against most anaerobic intestinal bacteria significantly increases the intestinal yeast burden without influencing the incidence of IFI in patients undergoing allogeneic BMT. Bone Marrow Transplantation (2000) 26, 993-997. Keywords: invasive fungal infection; BMT; metronidazole; total gut decontamination; aGVHD Invasive fungal infections (IFI) are increasingly diagnosed in immunocompromised patients after allogeneic stem cell transplantation (SCT). Once a diagnosis of IFI has been made, mortality is high. Prevention of aGVHD is an important factor determining transplant-related morbidity and mortality caused by IFI. 1,2 This is not only due to a decreased administration of immunosuppressive drugs but also to the immunosuppressive effect of aGVHD by itself.Acute GVHD results from an inflammatory process of recipient tissues that is induced by donor T cell clones.

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“…3 Other putative risk factors are frequent peritonitis, malnutrition, and an immunosuppressed state. 4 It is believed that antibiotics may allow for fungal proliferation by eliminating the normal skin flora.…”

Section: Introductionmentioning

confidence: 99%

Prophylaxis against fungal peritonitis in CAPD – a single center experience with low-dose fluconazole

et al. 2010

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Background/aims: Fungal peritonitis (FP) significantly alters the outcome of patients on peritoneal dialysis (PD). Exposure to antibiotics is a risk factor for subsequent FP. Antifungal prophylaxis has been tried, with varying success, to prevent the occurrence of antibiotic-related fungal peritonitis (AR-FP). We aimed to evaluate the effect of prophylaxis with a low dose of fluconazole, in preventing AR-FP. Methods: In this retrospective review, we examined the incidence of FP in a cohort of 115 patients, who had received antibiotics for bacterial peritonitis and received a co-prescription of fluconazole, 50 mg/day for the duration of antibiotic therapy. The incidence of bacterial peritonitis and FP for up to 3 months after antibiotic therapy was noted. Results: One hundred and fifteen patients were followed up over a 6-year period, for 2549 patient-months. We observed 82 episodes of bacterial peritonitis and a total of 137 antibiotic prescriptions. The peritonitis rate was 1 episode per 31.08 patient-months (1 per 2.58 patient-year, 0.38 episodes every patient-year). We had six episodes of FP. There were no episodes of AR-FP. Conclusion: We observed very low rates of both bacterial peritonitis and FP, and prophylaxis with low-dose fluconazole seemed to confer protection against AR-FP. We did not encounter any adverse effects with its use.

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Prospective evaluation of effects of broad-spectrum antibiotics on gastrointestinal yeast colonization of humans

Cited by 156 publications

References 24 publications

The human gut mycobiome: pitfalls and potentials--a mycologists perspective

The human gut mycobiome: pitfalls and potentials--a mycologists perspective

Fungal colonization and invasive fungal infections following allogeneic BMT using metronidazole, ciprofloxacin and fluconazole or ciprofloxacin and fluconazole as intestinal decontamination

Prophylaxis against fungal peritonitis in CAPD – a single center experience with low-dose fluconazole

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