Lactobacillus reuteri and Escherichia coli in the human gut microbiota may predict weight gain associated with vancomycin treatment

Abstract

Background:Antibiotics, used for 60 years to promote weight gain in animals, have been linked to obesity in adults and in children when administered during early infancy. Lactobacillus reuteri has been linked to obesity and weight gain in children affected with Kwashiorkor using ready-to-use therapeutic food. In contrast, Escherichia coli has been linked with the absence of obesity. Both of these bacteria are resistant to vancomycin.Objectives and methods:We assessed vancomycin-associated weight and gut microbiota changes, and tested whether bacterial species previously linked with body mass index (BMI) predict weight gain at 1 year. All endocarditis patients treated with vancomycin or amoxicillin in our center were included from January 2008 to December 2010. Bacteroidetes, Firmicutes, Lactobacillus and Methanobrevibacter smithii were quantified using real-time PCR on samples obtained during the 4–6 weeks antibiotic regimen. L. reuteri, L. plantarum, L. rhamnosus, Bifidobacterium animalis and E. coli were quantified on stool samples obtained during the first week of antibiotics.Results:Of the193 patients included in the study, 102 were treated with vancomycin and 91 with amoxicillin. Vancomycin was associated with a 10% BMI increase (odds ratio (OR) 14.1; 95% confidence interval (CI; 1.03–194); P=0.047) and acquired obesity (4/41 versus 0/56, P=0.01). In patients treated with vancomycin, Firmicutes, Bacteroidetes and Lactobacillus increased, whereas M. smithii decreased (P<0.05). The absence of E. coli was an independent predictor of weight gain (OR=10.7; 95% CI (1.4–82.0); P=0.02). Strikingly, a patient with an 18% BMI increase showed a dramatic increase of L. reuteri but no increase of E. coli.Conclusion:The acquired obesity observed in patients treated with vancomycin may be related to a modulation of the gut microbiota rather than a direct antibiotic effect. L. reuteri, which is resistant to vancomycin and produces broad bacteriocins, may have an instrumental role in this effect.

Abnormal Weight Gain and Gut Microbiota Modifications Are Side Effects of Long-Term Doxycycline and Hydroxychloroquine Treatment

“…Recently, the level and extent of M. smithii colonization were demonstrated as predictive of the degree of weight gain in an animal model (29). In addition, Lactobacillus and particularly L. reuteri have been associated with obesity, whereas E. coli has been associated with weight modifications (9,20,21). However, in the present study, no differences in the concentrations of L. reuteri, E. coli, and M. smithii between treated patients and controls were observed.…”

“…In humans, antibiotic treatment is commonly used as complement therapy for malnutrition (5,6), leading many researchers to reconsider the impact of the antibiotics administered during early infancy for the treatment of obesity in childhood (7). In addition, vancomycin has been associated with reduced microbial diversity (8), weight gain, and acquired obesity in adults (9,10).…”

The role of gut microbiota in the development of type 1, type 2 diabetes mellitus and obesity

“…Million et al (2013) investigated the body weight and gut microbiota changes in patients with bacterial endocarditis who were treated with either vancomycin or amoxicillin. Vancomycin was associated with a 10% BMI increase and acquired obesity, accompanied by increased proportions of Firmicutes, Bacteroidetes and Lactobacillus and decreased M. smithii [88]. Our mouse study supported the observation that early life exposure to vancomycin significantly promoted body weight gain in C57BL/J6 mice on a normal diet (Yuksel, Guo and Wen, unpublished data).…”

Short- and long-term effects of oral vancomycin on the human intestinal microbiota

“…1–4 Consequently, alterations of the microbiota composition induced by antibiotics can promote pathology, including obesity, asthma or infectious diseases. 2,5–7 Thus, understanding the effects that specific antibiotics have on the human intestinal microbiota is crucial for clinicians in order to choose the most efficacious (and otherwise less deleterious) of the therapeutic options available for treating infections.…”