Quantifying antibiotic impact on within-patient dynamics of extended-spectrum beta-lactamase resistance.
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 32379042.
- Also identified by DOI 10.7554/eLife.49206 and PMC identifier 7205461.
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Abstract
Antibiotic-induced perturbation of the human gut flora is expected to play an important role in mediating the relationship between antibiotic use and the population prevalence of antibiotic resistance in bacteria, but little is known about how antibiotics affect within-host resistance dynamics. Here we develop a data-driven model of the within-host dynamics of extended-spectrum beta-lactamase (ESBL) producing <i>Enterobacteriaceae</i>. We use bla<sub>CTX-M</sub> (the most widespread ESBL gene family) and 16S rRNA (a proxy for bacterial load) abundance data from 833 rectal swabs from 133 ESBL-positive patients followed up in a prospective cohort study in three European hospitals. We find that cefuroxime and ceftriaxone are associated with increased bla<sub>CTX-M</sub> abundance during treatment (21% and 10% daily increase, respectively), while treatment with meropenem, piperacillin-tazobactam, and oral ciprofloxacin is associated with decreased bla<sub>CTX-M</sub> (8% daily decrease for all). The model predicts that typical antibiotic exposures can have substantial long-term effects on bla<sub>CTX-M</sub> carriage duration.
Medical subject headings
- Anal Canal
- Anti-Bacterial Agents
- Bacterial Proteins
- Enterobacteriaceae
- Gastrointestinal Microbiome
- beta-Lactam Resistance
- beta-Lactamases