Infants with sepsis exposed to antibiotics have altered gut microbiomes - Healio

WASHINGTON — Neonates with sepsis were exposed to much antibiotics passim their NICU admissions than controls and were recovered to person microbiome dysbiosis, researchers reported.

Hope Hendricks, MD, a pediatric infectious diseases chap astatine Vanderbilt University Medical Center, presented findings from the survey astatine IDWeek. In her remarks, Hendricks noted that probe successful the country of neonatal infections is important due to the fact that of the “the wide morbidity and mortality, accrued hazard for antibiotic adverse events and for resistant infections successful this diligent population.”

Hendricks, et al.

“We cognize that premature neonates are astatine precocious hazard for superior bacterial infections, person predominant and [broad-spectrum] antibiotic courses, and that the lit antecedently has shown that alterations to the maturing gut microbiome successful the signifier of dysbiosis precede superior objective complications, including [necrotizing enterocolitis] and sepsis,” Hendricks said successful her presentation.

Hendricks and colleagues established an babe stool biorepository, and for the survey they collected much than 1,300 stool samples from 265 infants successful NICUs weighing little than 2 kilos astatine commencement and aged younger than 2 months. They sought to qualify however antibiotic vulnerability affected the improvement of intestinal dysbiosis successful infants with bloodstream infections (BSI) compared with power infants, who had little than 5 days of antibiotic exposure, nary BSI oregon necrotizing enterocolitis.

According to Hendricks, 2 to 5 weeks aft collecting the samples, the researchers observed that the power infants had much anaerobes — oregon steadfast gut colonizers — than lawsuit infants who provided samples earlier processing sepsis. Later, astatine the 6- to-13-week point, power samples continued to person an expanding anaerobe presence, but the lawsuit samples had developed an abundance of Enterococcus species.

“When we look astatine overmuch older samples, successful the cases aft the sepsis lawsuit astatine 14 to 20 weeks’ postnatal age, we spot a betterment of anaerobes but a persistence of the Enterococcus abundance,” Hendricks said.

The authors besides recovered that successful 7 of 8 BSI cases, the causative pathogen was identified successful the pre-BSI stool sample. In 2 further BSI cases, the patients did not person a pre-BSI stool sample. In six of the cases, identified to person precocious beta-lactam exposure, 3 had notable increases successful the comparative abundance of Enterococcus species.

However, the abundance antibiotic absorption genes successful the intestinal flora of infants did not disagree betwixt cases and controls, according to the researchers.

Hendricks and colleagues besides examined however antibiotic vulnerability played a relation successful the altered gut microbiomes of neonatal sepsis. To bash that, they relied chiefly connected the Antibiotic Spectrum Index (ASI), a instrumentality developed by Gerber and colleagues that classifies commonly utilized antibiotics based connected their enactment against definite pathogens. Based connected the index, they assigned a people for each infant, giving an estimation of however overmuch antibiotic vulnerability had occurred.

“When we usage this ASI score, we tin spot that sepsis cases had overmuch higher antibiotic exposure,” Hendricks said.

The full cohort successful the biorepository of 363 infants had an mean cumulative ASI people of 63 for their full NICU admission, whereas cases earlier their sepsis lawsuit had an mean people of 84.

“We recovered that compared [with] noninfected controls, neonatal sepsis cases had little alpha diversity, little abundant anaerobes and much predominant and broader spectrum antibiotics,” Hendricks said. “Those cases with precocious beta-lactam usage had Enterococcus predominance successful the stool, which begs the question of whether Enterococcus-sparing antibiotic regimens play a heightened relation successful gut dysregulation and imaginable aboriginal infectious events, and whether antibiotic metrics successful the aboriginal could relationship for this differential harm to the microbiome.”

References:

Gerber JS, et al. Infect Control Hospital Epidemiol. 2017;doi:10.1017/ice.2017.94.

Hendricks H, et al. Abstract 779. Presented at: IDWeek; Oct. 19-23, 2022; Washington (hybrid meeting).