Prenatal and postnatal antibiotic exposure influences the gut microbiota of preterm infants in neonatal intensive care units

Zou, Zhi-Hui; Liu, Dong; Li, Hongdong; Zhu, Dong; He, Yu; Hou, Tao; Yu, Jialin

doi:10.1186/s12941-018-0264-y

Cited by 78 publications

(70 citation statements)

References 42 publications

(38 reference statements)

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“…However, more research towards best IAP management for women delivering preterm is needed, as long-term exposure to antibiotics poses a risk for preterm infants. 54 Ideally, immunisation of mothers should be introduced to prevent EOGBS invasive infections, but although research in this field has been going on for years, no effective GBS vaccine has been made available so far. 18 Until that time, it is recommended that the GBS prevention protocols are periodically re-evaluated, and research aimed at accurate and fast detection methods for all pregnant women is continued.…”

Section: Discussionmentioning

confidence: 99%

Universal screening versus risk‐based protocols for antibiotic prophylaxis during childbirth to prevent early‐onset group B streptococcal disease: a systematic review and meta‐analysis

Hasperhoven

Al‐Nasiry

Bekker

et al. 2020

BJOG

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Background Early‐onset group B streptococcal (EOGBS) disease (including sepsis, meningitis, and pneumonia) causes significant morbidity and mortality in newborn infants worldwide. Antibiotic prophylaxis can prevent vertical streptococcal transmission, yet no uniform criteria exist to identify eligible women for prophylaxis. Some guidelines recommend universal GBS screening to pregnant women in their third trimester (screening‐based protocol), whereas others employ risk‐based protocols. Objectives To compare the effectiveness of screening‐based versus risk‐based protocols in preventing EOGBS disease. Search strategy Key words for the database searches included GBS, Streptococcus agalactiae, pregnancy, screening, culture‐based, risk‐based. Selection criteria Studies were included if they investigated EOGBS disease incidence in newborn infants and compared screening or risk‐based protocols with each other or with controls. Data collection and analysis Risk ratios (RR) and 95% confidence intervals (CI) were determined using Mantel‐Haenszel analyses with random effects. Main results Seventeen eligible studies were included. In this meta‐analysis, screening was associated with a reduced risk for EOGBS disease compared either with risk‐based protocols (ten studies, RR 0.43, 95% CI 0.32–0.56) or with no policy (four studies, RR 0.31, 95% CI 0.11–0.84). Meta‐analysis could not demonstrate a significant effect of risk‐based protocols versus no policy (seven studies, RR 0.86, 95% CI 0.61–1.20). In studies reporting on the use of antibiotics, screening was not associated with higher antibiotic administration rates (31 versus 29%). Conclusions Screening‐based protocols were associated with lower incidences of EOGBS disease compared with risk‐based protocols, while not clearly overexposing women to antibiotics. This information is of relevance for future policymaking. Tweetable abstract Meta‐analysis: general screening is associated with lower rates of early‐onset group B strep. neonatal sepsis compared with risk‐based protocols.

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Section: Discussionmentioning

confidence: 99%

Universal screening versus risk‐based protocols for antibiotic prophylaxis during childbirth to prevent early‐onset group B streptococcal disease: a systematic review and meta‐analysis

Hasperhoven

Al‐Nasiry

Bekker

et al. 2020

BJOG

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“…Microbial colonization is influenced as early as birth by mode of delivery, and perhaps even in the uterine environment by maternal factors 15,16 . Not surprisingly, antibiotic use has been shown to also change the composition of the preterm gut community 17–20 . Furthermore, antibiotic use early in life has increasingly been associated with adverse outcomes both short- and long-term 21,22 .…”

Section: Mainmentioning

confidence: 99%

Antibiotics and the developing intestinal microbiome, metabolome and inflammatory environment: a randomized trial of preterm infants

Russell

Ruoss

Cruz

et al. 2020

Preprint

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15Antibiotic use in neonates can have detrimental effects on the developing gut microbiome, 16increasing the risk of morbidity. A majority of preterm neonates receive antibiotics after birth 17 without clear evidence to guide this practice. Increasing evidence suggests associations between 18 early-life antibiotic use, intestinal dysbiosis, and morbidity that challenge the efficacy of this 19 common neonatal practice. Here we present microbiome and metabolomic results from the 20 Routine Early Antibiotic use in Symptomatic preterm Neonates (REASON) study, which is the 21 first trial to randomize symptomatic preterm neonates to receive or not receive antibiotics in the 22 first 48 hours after birth. Using 16S rRNA sequencing of stool samples collected longitudinally 23for 91 neonates, we show that antibiotics alter trends in microbiome diversity and development 24 between randomized neonates and illustrate that type of nutrition helps shape the early infant gut 25 microbiome. Integrating multi-omic data for the gut microbiome, stool immune markers, stool 26 metabolites, and inferred metabolic pathways, we identified an association between Veillonella 27 and the neurotransmitter gamma-aminobutyric acid (GABA). Our results suggest early antibiotic 28 use may impact the gut-brain axis with the potential for consequences in early life development. 29 Main 30Premature infants are particularly susceptible to infections secondary to increased need for 31 invasive procedures and immaturity of the immune system, skin, and gastrointestinal tract1-3. 32Increasingly, there is growing concern that risk factors for mortality may originate from 33underlying pathologies that could also be responsible for premature birth4. Symptoms of 34 prematurity are difficult to discern from symptoms of infection which, compounded by the 35 3 increased risk of infection, have led to most premature infants being exposed to antibiotics early 36 in life5-7. Despite high mortality rates, the incidence of culture positive early onset sepsis (EOS) 37 is relatively low, between 0.2-0.6%8. In the absence of a positive culture, a majority of preterm 38 infants receive antibiotics immediately after birth based on maternal risk factors (e.g. intra-39 amniotic infection) or laboratory abnormalities (e.g. elevated serum C-reactive protein (CRP) 40 because of the risk of mortality8. Given the low incidence of culture positive EOS in this 41 population, it is possible that such high rates of antibiotic use are unnecessary and may increase 42 morbidity in these infants9. Other morbidities in the neonatal intensive care unit (NICU) such as 43 necrotizing enterocolitis (NEC) also have high mortality rates and have been associated with 44 prolonged antibiotic exposure.10,11. Nevertheless, antibiotics remain the most commonly 45 prescribed medication in the NICU12,13. 46The gut microbiome comprises a highly volatile community structure early in life14. Microbial 47Randomized clinical trials have the advantage of controlling for the numerous covariates that 58 cou...

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“…Antibiotic treatment can impact entire microbial communities, also known as microbiota, and the metabolites they produce for months or longer [10]. Interestingly, antibiotics taken in pregnancy have been associated not only with altered maternal microbiota but also with impacted infant microbiota [11,12], suggesting antibiotics may affect fetal microbiota or metabolite exposure. Maternal microbiota and metabolites in utero may help train the fetal innate immune system and have been causally implicated in allergic airway disease in mice [13,14].…”

mentioning

confidence: 99%

Maternal antibiotic use and child asthma: is the association causal?

2018

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Prenatal and postnatal antibiotic exposure influences the gut microbiota of preterm infants in neonatal intensive care units

Cited by 78 publications

References 42 publications

Universal screening versus risk‐based protocols for antibiotic prophylaxis during childbirth to prevent early‐onset group B streptococcal disease: a systematic review and meta‐analysis

Universal screening versus risk‐based protocols for antibiotic prophylaxis during childbirth to prevent early‐onset group B streptococcal disease: a systematic review and meta‐analysis

Antibiotics and the developing intestinal microbiome, metabolome and inflammatory environment: a randomized trial of preterm infants

Maternal antibiotic use and child asthma: is the association causal?

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