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.
Highlights
Stokstad et al.[1] first found that the administration of Streptomyces aureofaciens led to a twofold weight increase in chickens, and identified that one of its bacteriocins, chlortetracycline, was responsible for this effect
The proportion of patients with an increase for more than 10% body mass index (BMI) was higher in the vancomycin group (5/41 (12.2%)) than in the amoxicillin group (1/56 (1.8%), P 1⁄4 0.038)
Acquired the amoxicillin group showed no significant difference compared obesity was observed in four individuals who had all been treated with the control group (P 1⁄4 0.58) (Figure 2)
Summary
Stokstad et al.[1] first found that the administration of Streptomyces aureofaciens led to a twofold weight increase in chickens, and identified that one of its bacteriocins, chlortetracycline, was responsible for this effect. For over 60 years since antibiotics, including mainly glycopeptides, tetracycline, macrolides and penicillins, have been used at subtherapeutic levels to promote weight gain in animals. 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. Escherichia coli has been linked with the absence of obesity Both of these bacteria are resistant to vancomycin. 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
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