Abstract
BackgroundThe proportion of infections among young children that are antimicrobial-resistant is increasing across the globe. Newborns may be colonized with enteric antimicrobial-resistant pathogens early in life, which is a risk factor for infection-related morbidity and mortality. Breastfeeding is actively promoted worldwide for its beneficial impacts on newborn health and gut health. However, the role of breastfeeding and human milk components in mitigating young children’s carriage of antimicrobial-resistant pathogens and antibiotic resistance genes has not been comprehensively explored.Main bodyHere, we review how the act of breastfeeding, early breastfeeding, and/or human milk components, such as the milk microbiota, secretory IgA, human milk oligosaccharides, antimicrobial peptides, and microRNA -bearing extracellular vesicles, could play a role in preventing the establishment of antimicrobial-resistant pathogens in young children’s developing gut microbiomes. We describe findings from recent human studies that support this concept.ConclusionGiven the projected rise in global morbidity and mortality that will stem from antimicrobial-resistant infections, identifying behavioral or nutritional interventions that could decrease children’s susceptibility to colonization with antimicrobial-resistant pathogens may be one strategy for protecting their health. We suggest that breastfeeding and human milk supplements deserve greater attention as potential preventive measures in the global effort to combat antimicrobial resistance, particularly in low- and middle-income settings.
Highlights
ConclusionGiven the projected rise in global morbidity and mortality that will stem from antimicrobial-resistant infections, identifying behavioral or nutritional interventions that could decrease children’s susceptibility to colonization with antimicrobial-resistant pathogens may be one strategy for protecting their health
The proportion of infections among young children that are antimicrobial-resistant is increasing across the globe
We suggest that breastfeeding and human milk supplements deserve greater attention as potential preventive measures in the global effort to combat antimicrobial resistance, in low- and middle-income settings
Summary
Multiple strategies have been proposed to prevent the coming global antimicrobial resistance emergency, including the development of new antibiotics and vaccines, improved surveillance and education, and improved hospital infection control [1]. Given that AMR pathogens are increasingly prevalent in community settings, earlylife interventions like breastfeeding that could protect children against community-acquired gut colonization and infection should be actively explored. Recent evidence supports the role of breastfeeding in preventing the acquisition, establishment, and proliferation of enteric pathogens, including AMR bacteria, in young children’s guts by reducing children’s early-life exposures to contaminated foods and inappropriate antibiotic use. The emerging mechanistic pathways through which human milk components including the milk microbiota, maternal antibodies, HMOs, antimicrobial peptides, and EVs may protect against early-life colonization by AMR pathogens and ARGs warrant further exploration as novel targets for intervention, and/or supplementation where optimal breastfeeding practices are not possible.
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