Antibiotic-treated Group Research Articles

Association of early antibiotic therapy and in-hospital mortality in adult mild-to-moderate acute aspiration pneumonitis: a cohort study

Patients with aspiration pneumonitis often receive empiric antibiotic therapy despite it being due to a non-infectious, inflammatory response. To study the benefits of early antibiotic therapy in patients with suspected aspiration pneumonitis in an acute care hospital. Retrospective cohort study using electronic medical records from Teine Keijinkai Hospital. Adults aged over 18years admitted with a diagnosis of aspiration pneumonitis to the Department of General Internal Medicine or Emergency Department between January 1, 2008, and May 31, 2019. A diagnosis of aspiration pneumonitis was defined as a documented macro-aspiration event and a chest radiograph demonstrating new radiographic infiltrates. Patients were classified into the "early antibiotic treatment" group and the "no or late treatment" group depending on whether they received antibiotic therapy for respiratory bacterial pathogens within 8h of arrival. The primary outcome was in-hospital all-cause mortality. Secondary outcomes included length of hospital stay, antibiotic-free days, duration of fever, readmission within one month, and incidence of complications. Of the 146 patients enrolled, 52 (35.6%) did not receive early antibiotic therapy, while the remaining 94 (64.4%) did. There was no difference in in-hospital mortality rates between the groups after adjustment for potential confounding variables using Cox proportional hazards analysis (hazard ratio 2.78; 95% confidence interval, 0.57-13.50, p = 0.20). Patients in the no or late treatment group had more antibiotic-free days (p < 0.001) and a shorter length of hospital stay among survivors (p = 0.040) than did those in the early antibiotic treatment group. There were no statistically significant differences between the groups with respect to other secondary outcomes. Early antibiotic therapy for acute aspiration pneumonitis was not associated with in-hospital mortality, but was associated with a longer hospital stay and prolonged use of antibiotics.

Study on the Efficacy of Nanoantibiotics in Rats with Sepsis Based on MicroRNA-195 and TGF-β1/Smads Signaling Pathway.

In order to explore the efficacy of nanoantibiotics in rats with sepsis based on MicroRNA-195 and TGF-β1/Smads signaling pathway, a total of 160 Wistar rats with sepsis were selected and randomly divided into 4 groups of general antibiotics (GA) treatment group and nanoantibiotics treatment (NT) group, MicroRNA-195 treatment (MT) group and TGF-β1/Smads (TS) treatment group with 40 sepsis rates in each group. After each group was treated for 24 hours, the supernatant was centrifuged, the enzyme-labeled reagent was added to sample wall, the absorbance value of each well in sequence was measured, and the linear regression equation of the standard curve was calculated based on the concentration and absorbance value of the standard. Before and after the experiment, the changes in body weight, mental state, activity, respiration, and abdominal cavity of species rats in each group were observed and measured; the expression of Interleukin-1 (IL-1), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10), TGF-β1, Smad2, Smad3, Smad7 were recorded and analyzed. The results showed that the expression levels of IL-1, TNF-α, TGF-β1, Smad2, Smad3 and Smad7 in sepsis rats in GA group were higher than those in the NT group (P < 0.05); the myocardial cells in MT group were significantly smaller and the cell arrangement was tighter and more orderly than those in TS group; and the expression levels of TNF-α, IL-6, TGF-β1, Smad2, Smad3, and Smad7 were significantly reduced (P < 0.05). In summary, the MicroRNA-195 and TGF-β1/Smads may promote cardiac remodeling in sepsis rats by up-regulating the nanoantibiotics signaling transduction pathway, thereby having objective curative effect on sepsis rats. The study results of this paper provide a reference for further research on the efficacy of nanoantibiotics in sepsis rats based on MicroRNA-195 and TGF-β1/Smads signaling pathway.

Gut microbiota affects the efficacy of Danggui Buxue Tang by affecting plasma concentration of active ingredients

Ethnopharmacological relevanceDanggui Buxue Tang (DBT) is a traditional Chinese medicine, which has the function of supporting Qi and enriching blood. Antibiotics can cause Gut microbiota disorder and affect efficacy of DBT. Aim of the studyExplore the manner in which Gut microbiota affects the efficacy of Danggui Buxue Tang. Materials and methodsIn this study, antibiotics were used to destroy gut microbiota. The changes of DBT efficacy were detected to verify the effect of gut microbiota on DBT efficacy. The changes of gut microbiota was detected using 16S rRNA sequencing, and UPLC-MS/MS was used to analyze the plasma concentration of active ingredients. Correlation analysis was used to establish the relationship between gut microbiota, blood components and drug efficacy, and to explore the role of gut microbiota in the efficacy of DBT. ResultsThe results showed that the efficacy in the DBT group was significantly improved compared with the control group (p<0.05). Compared with DBT group, the efficacy in antibiotic DBT treatment (ABXDBT) group was significantly reduced, 194 plasma metabolites and 18 DBT blood components were significantly altered in ABXDBT group, and 11 DBT blood components such as caffeic acid and formononetin were significantly decreased. Correlation analysis showed that 6 DBT blood components were related with the decrease of efficacy. Network pharmacology analysis showed that the above 6 DBT blood components participated in the hematopoietic regulation through PI3K-Akt and HIF-1 signaling pathways. Correlation analysis showed that Bacteroides and other intestinal bacteria were related to the absorption of DBT active ingredients. The drug metabolic pathway of gut microbiota was significantly decreased after antibiotic treatment (p = 0.033). ConclusionsGut microbiota such as Bacteroides affects the efficacy of DBT by affecting the metabolism and absorption of DBT active ingredients such as caffeic acid and formononetin.

Can antibiotic treatment failure in tubo-ovarian abscess be predictable?

IntroductionWe aimed to identify factors that would predict the success of antibiotic treatment and the need for surgical treatment in tubo-ovarian abscess (TOA) patients. Materials and methodsThe data of 146 patients with a diagnosis of TOA were analyzed retrospectively. Patients were separated into two groups; successfully treated with antibiotics and going under surgery after antibiotic treatment failure. Demographic, clinical and laboratory data of patients were examined between both groups that could determine the success of treatment. ResultsIn the surgical treatment group, age, body mass index (BMI), and C-reactive protein (CRP) values ​​were higher than the antibiotic treatment group (p = 0.017, p = 0.026, and p < 0.001 respectively). Patients who underwent surgery had a significantly larger abscess than those who received antibiotic therapy (79.4 ± 21.1 mm vs. 50.9 ± 13.2 mm, p < 0.001). Cut-off values of the findings, which were identified as risk factors in predicting the failure of antibiotic treatment, were found with ROC analyses. This cut-off was 41.5 years for age (sensitivity 71.3 %, specificity 60 %), 26.72 kg/m2 for BMI (sensitivity 51.5 %, specificity 71.1 %), and 143.5 mg/L for CRP value on admission (sensitivity 68.3 %, specificity 71.1 %). The cut-off for abscess diameter was 62.5 mm (sensitivity 88.1 %, specificity 82.2 %). ConclusionEspecially in large tubo-ovarian abscesses, early surgical intervention should be preferred considering the age, BMI, and CRP values.

The modified endoscopic retrograde appendicitis therapy versus antibiotic therapy alone for acute uncomplicated appendicitis in children.

Endoscopic retrograde appendicitis therapy (ERAT) is an emerging endoscopic treatment modality for acute uncomplicated appendicitis (AUA) supported by several case series. However, to date, systematic studies have not been conducted in children and the prospective comparative data are lacking. Moreover, due to a concern for future malignancy risk in children from ionizing radiation, we used contrast-enhanced ultrasound (CEUS) instead of endoscopic retrograde appendiceal radiography (ERAR). Therefore, we conducted a prospective, randomized control clinical trial to compare the modified ERAT (mERAT) to antibiotic therapy in children with AUA. The aim of this study was to evaluate the safety and feasibility and of mERAT in the treatment of hospitalized children with AUA. Children with AUA, confirmed by ultrasonography and or abdominal computed tomography, were consecutively enrolled from October 2018 to February, 2020. They were randomly assigned to receive mERAT or routine antibiotic treatment. Patients were followed until May, 2020. Th primary outcome variable was the duration of relief of the abdominal pain after treatment. We collected patient's demographics, ultrasonic imaging findings, colonoscopy findings, and treatment outcomes of the mERAT and adverse even associated with mERAT. A total of 83 children were enrolled. 36 were randomized to mERAT and 47 to antibiotics treatment. All children in the mERAT group had endoscopic confirmed acute uncomplicated appendicitis, and there were no significant complications. However, 9 of patients in antibiotic group were poor responsive to treatment and switched to mERAT. The overall success rate of treatment with mERAT (100%) was significantly higher than that of antibiotics (80.9%) (P = 0.004). The median time to discharge was significantly shorter in mERAT group than in antibiotics treatment group [6.0 ± 1.76days] (P = 0.004). mERAT provide a new alternative therapeutic option for childhood with AUA, especially for families who are reluctant to undergo an appendectomy.

Gut Microbiome Dysbiosis Alleviate the Progress of Osteoarthritis in Mice

Objective: To evaluate the contribution of gut microbiota dysbiosis on the development of osteoarthritis (OA) in different gender mice. Design: We used a mouse OA model (8 weeks) of the destabilization of the medial meniscus(DMM) and gut microbiome dysbiosis induced by antibiotic treatment (ABT) with ampicillin and neomycin for 8 weeks. The severity of OA was evaluated by micro-CT scanning, X-rays and the Osteoarthritis Research Society International (OARSI) histology score. Microbiome analysis via PCR of 16S DNA was performed on fecal samples, and the serum LPS, IL-6, TNF-α, osteocalcin, estrogen, calcium and magnesium ion levels were measured by enzyme-linked immunosorbent assay (ELISA). Finding: Compared to those in normal mice, the bone volume over total volume (BV/TV) (P<0.01) and the OARSI score (P<0.01) in subchondral bone decreased significantly in the female and male ABT treatment groups. ABT decreased the osteophyte score in female mice in the standard normal group (P<0.05) and decreased the osteophyte maturity score in both female (P<0.01) and male (P<0.05) mice. The levels of IL-6 (P<0.01), TNF-α (P<0.01 for both subgroups), calcium (P<0.01) and expression of MMP-13 were decreased significantly in the ABT group compared with those in the control group, while magnesium and estrogen were increased significantly in the ABT-female group compared with those in the control-female group (P<0.01). For DMM surgery treatment, BV/TV (P<0.01) and serum level of IL-6 (P<0.01) were decreased significantly but the ratio of serum level of Ca2+ and Mg2+ increased significantly in male mice compare than female mice. the bone volume over total volume (BV/TV) of subchondral bone sclerosis has been increased significant in female mice after joint injury than male mice. However, trabecular thickness (Tb.Th) and osteophyte score have been increased significantly in antibiotic-induced male mice than female mice. We further used network correlations analysis to verify the effect of gut microbiota dysbiosis on OA. Interpretation: Our data showed the factors to the gut microbiome dysbiosis alleviating the progression of OA. Funding Statement: This work was partly supported by the National Natural Science Foundation of China (Grants no. 81874010, 81672133). Declaration of Interests: The authors have declared that no conflict of interest exists. Ethics Approval Statement: The experiments and protocol were approved by The Peking University Third Hospital Committee on Ethics in the Care and Use of Laboratory Animals (No. LA2019209).

Effects of Antibiotics on the Bacterial Community, Metabolic Functions and Antibiotic Resistance Genes in Mariculture Sediments during Enrichment Culturing

The effect of antibiotics on the diversity and functioning of indigenous microorganisms in the environment has attracted much attention. In this study, effects of exposure to six different antibiotics on the bacterial community, metabolic functions and antibiotic resistance genes (ARGs) in marine sediments during enrichment culturing were investigated. Classical culture-dependent method and high-throughput 16S rRNA gene sequencing method were both applied. In the culture-dependent analysis, the obtained 1549 isolates belonged to four phyla (Proteobacteria, Firmicutes, Bacteroidetes and Actinobacteria) and 155 genera. Proteobacteria and Firmicutes were the dominant phyla. The diversity and abundance of obtained bacteria after antibiotic processing exhibited different degrees of decrease. Enrichment culturing for different time could also affect the bacterial community composition. Some genera of bacteria were not isolated in the control group, but they could be isolated in the antibiotic-treated groups. In high-throughput 16S rRNA gene amplicon sequencing analyses, all the effective reads were clustered into 2822 OTUs at 97% similarity cutoff; they were annotated to 49 phyla, 103 class, 220 orders, 347 families, 624 genera and 1122 species. An alpha diversity analysis indicated that the community diversity and richness decreased under antibiotic exposure. The changes at the genus level were much more obvious. Only 48 genera of 129 genera were shared by all the samples. A total of 29 genera which were not detected in the initial control sample could be detected in at least one antibiotic-treated group. SIMPER analysis showed that OTU2543 and OTU1450 were the most common taxa to the dissimilarity of bacterial community between antibiotic-treated groups and the control group. OTU2034 and OUT2543 were the most contributive taxa to dissimilarity of groups incubating for different time. Metabolism was the predominant bacterial function. A total of 30 ARGs were detected in the samples. This study mainly focused on the changes of microbiota under the selective pressure of antibiotics for different time and the results demonstrated that the antibiotic could affect the bacterial diversity and richness in the marine ecosystem.

Antibiotic is a safe and feasible option for uncomplicated appendicitis in pregnancy - A retrospective cohort study.

Acute appendicitis is the commonest surgical emergency during pregnancy. The aim of this study is to evaluate the outcomes between antibiotic therapy and appendectomy in the management of uncomplicated appendicitis during gestation. From January 2015 to April 2019, there were 2174 emergency appendicitis diagnosed in the University of Hong Kong-Shenzhen Hospital. Among them, 54 pregnant women were diagnosed with acute uncomplicated appendicitis and the clinical records were reviewed. Clinical demographics and outcomes including gestational age at delivery, mode of delivery, birth weight, APGAR score at 1 minute, fetal loss and overall length of stay were compared between the operation group and the antibiotic treatment group. The baseline characteristics showed no statistically significant difference between the two groups (P > .05). In the appendectomy group (n = 20), one patient had wound infection while none of the patients in the antibiotic therapy group (n = 34) experienced any complication. In the antibiotic treatment group, appendicitis recurred in one patient during pregnancy and in two patients after deliveries, which were all treated with appendectomy. The mean hospital stay of the antibiotic treatment group was shorter than that of the appendectomy group, but there was no significant difference (4.94 ± 2.6 days vs 6.25 ± 3.5 days, P = .540). There was no difference in gestational age at delivery, mode of delivery, birth weight and APGAR scores between the two groups (P > .05). For acute uncomplicated appendicitis during pregnancy, antibiotics treatment is a safe and feasible option.

The value of calprotectin in synovial fluid for the diagnosis of chronic prosthetic joint infection.

AimsThis study aimed to evaluate calprotectin in synovial fluid for diagnosing chronic prosthetic joint infection (PJI) .MethodsA total of 63 patients who were suspected of PJI were enrolled. The synovial fluid calprotectin was tested by an enzyme-linked immunosorbent assay (ELISA). Laboratory test data, such as ESR, CRP, synovial fluid white blood cells (SF-WBCs), and synovial fluid polymorphonuclear cells (SF-PMNs), were documented. Chi-squared tests were used to compare the sensitivity and specificity of calprotectin and laboratory tests. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was calculated to determine diagnostic efficacy.ResultsThe median calprotectin level was 776 μg/ml (interquartile range (IQR) 536.5 to 1132) in the PJI group and 54.5 μg/ml (IQR, 38.75 to 78.25) in the aseptic failure (AF) group (p < 0.05). Using a threshold of 173 ug/ml, the sensitivity was 95.2%, with a 97.6% specificity, and the AUC was 0.993. The sensitivity of calprotectin of the antibiotic-treated PJI group was 100% versus 90.9% of the non-antibiotic-treated PJI group. Although 47.6% (ten cases) of the patients in the PJI group received antibiotics before aspiration, the diagnostic efficacy of calprotectin was not affected. The sensitivity and specificity of ESR, CRP, SF-WBCs, and SF-PMNs ranged from 76.2% to 90.5% and 64.3% to 85.7%, respectively.ConclusionCalprotectin in synovial fluid has great diagnostic efficacy for PJI diagnosisand outperformed ESR, CRP, SF-WBCs, and SF-PMNs.Cite this article: Bone Joint Res 2020;9(8):450–457.

Antibiotics Improve the Treatment Efficacy of Oxaliplatin-Based but Not Irinotecan-Based Therapy in Advanced Colorectal Cancer Patients.

Background Oxaliplatin and irinotecan are generally used to treat advanced colorectal cancer (CRC) patients. Antibiotics improve the cytotoxicity of oxaliplatin but not irinotecan in a colon cancer cell line in vitro. This study retrospectively assessed whether antibiotics improve the treatment efficacy of oxaliplatin- but not irinotecan-based therapy in advanced CRC patients. Patients and Methods. The medical records of 220 advanced CRC patients who underwent oxaliplatin- or irinotecan-based therapy were retrospectively reviewed. The oxaliplatin and irinotecan groups were further divided into antibiotic-treated (group 1) and antibiotic-untreated (group 2) subgroups. Results In oxaliplatin groups 1 and 2, the response rate (RR) was 58.2% and 30.2%, while the disease control rate (DCR) was 92.5% and 64.2%, respectively; the median progression-free survival (PFS) was 10.5 months (95% confidence interval (CI) = 7.5–12.2) and 7.0 months (95% CI = 17.0–26.0), respectively, and the median overall survival (OS) was 23.8 months (95% CI = 5.1–9.1) and 17.4 months (95% CI = 13.1–24.9), respectively. In irinotecan groups 1 and 2, the RR was 17.8% and 20.0%, while the DCR was 75.6% and 69.1%, respectively; the median PFS was 8.2 months (95% CI = 6.2–12.7) and 7.9 months (95% CI = 12.0–23.0), respectively, and the median OS was 16.8 months (95% CI = 5.9–10.6) and 13.1 months (95% CI = 10.4–23.7), respectively. Conclusion To improve the treatment efficacy of oxaliplatin-based therapy in advanced CRC patients, adding antibiotics is a potential therapeutic option.

Lycium barbarum relieves gut microbiota dysbiosis and improves colonic barrier function in mice following antibiotic perturbation

• Antibiotics decrease the microbial diversity and induce gut microbiota dysbiosis. • Lycium barbarum (LB) alters the gut microbiota and increases short chain fatty acids. • LB treatment can relieve the gut microbiota dysbiosis after antibiotic perturbation. • LB improves colonic barrier function by altering the gut microbiota composition. Diet and antibiotic strongly affect human health by modulating gut microbiota (GM) composition. To investigate how Lycium barbarum (LB) relieves GM dysbiosis and enhances colonic barrier function, C57BL/6 mice were chronically exposed to sub-therapeutic antibiotic dosages or not (control), and fed a 1.5% LB diet for 10 weeks. HiSeq sequencing of 16S rDNA revealed that oral antibiotics distinctly lowered the microbial diversity and richness, Bacteroidetes, Firmicutes, Bacteroidales_S24-7_group, Lachnospiraceae, Ruminococcaceae, Lachnospiraceae_NK4A136_group , Lachnoclostridium , Akkermansia , Anaerotruncus , and Odoribacter , as well as increased Proteobacteria, Enterobacteriaceae, Enterococcaceae, Escherichia-Shigella , Morganella , and Enterococcus . Compared with the antibiotic-treated group, dietary LB reversed the variations in these bacteria, improved the abundance of certain short-chain fatty acid (SCFA)-producing bacteria, SCFA concentrations, and decreased fecal ammonia and pH value. Accordingly, this promoted the expression of tight junction proteins, immune barrier, sequentially improved barrier function, histomorphology, and development in the intestine. The results show that dietary LB can partially mitigate antibiotics-induced dysbiosis.

Antibiotics Modulate Chemotherapy Efficacy in Patients with Esophageal Cancer.

PurposeAccumulating evidence suggests that microbiota dysbiosis induced by antibiotic administration plays a crucial role in regulating the efficacy and toxicity of cancer therapy. We explored the influence of antibiotic administration on the efficacy of chemotherapy in patients with esophageal cancer (EC).Patients and MethodsEC patients were stratified into two groups: antibiotic-treated group and control group. The antibiotic-treated group included patients who received antibiotics within 60 days before or after chemotherapy initiation, and the control group included patients who did not receive antibiotics within 60 days before or after chemotherapy initiation. Progression-free survival (PFS) and overall survival (OS) curves were constructed using the Kaplan–Meier method. The Cox proportional hazards model was used for univariate and multivariate analyses.ResultsThe rate of primary progressive disease in the antibiotic-treated group was significantly higher than that in the control group (36.58% vs 10.45%, p = 0.002) as calculated using the chi-square test. Further, antibiotic administration was associated with shorter PFS (6.7 vs 14.6 months, hazard ratio (HR): 2.545, 95% confidence interval (CI): 1.554–4.168, p < 0.001) and reduced OS (15.0 vs 21.0 months, HR: 2.007, 95% CI: 1.213–3.319, p = 0.007) in univariate analysis. Subsequent multivariate analysis indicated that antibiotic administration was a significant independent prognostic factor for PFS (HR: 2.350, 95% CI: 1.423–3.882, p = 0.001) and OS (HR: 1.900, 95% CI: 1.140–3.167, p = 0.014).ConclusionAntibiotic administration was associated with reduced chemotherapy efficacy and poor prognosis in patients with EC.

Antibiotic-induced dysbiosis of the rat oral and gut microbiota and resistance to Salmonella

ObjectivesAntibiotics play a great role in the treatment of infectious diseases, but meantime, they cause great disturbances to host microbiota. Studies on different antibiotic-induced changes in host microbiota are relatively scarce. This study aimed to investigate the changes in oral and gut microbiota and possible alterations of gut resistance to Salmonella induced by the administration of antibiotics. MethodsThe experiment was conducted by administering antibiotics to rats and detecting oral and gut microbiota by 16S rRNA gene sequencing. In second part, after treating with antibiotics or Lactobacillus rhamnosus the rats were infected by Salmonella Typhimurium and the pathogen burden in the gut was counted by colony forming unit assay. ResultsThe gut microbiota underwent dramatic changes after both vancomycin and ampicillin treatment. The alpha diversity sharply decreased, and the microbiota composition showed a significant difference. However, the gut microbiota recovered within four weeks after stopping antibiotics administration, although this recovery was incomplete. Oral microbiota did not show significant alterations in both alpha and beta diversities. The number of pathogens in the gut in the control group was significantly lower than that in the antibiotic-treated group but only lasted for the first 4 days after infection. ConclusionsAntibiotics cause dramatic alterations in the number and diversity of gut microbiota but not oral microbiota. These changes in the gut microbiota could incompletely recover four weeks later. When infected with pathogens after antibiotic administration, the rats show a decrease in colonization resistance in the gut for the first four days after infection.

Effect of antibiotic treatment on microbial composition and expression of antimicrobial peptides and cytokines in the chick cecum

The aim of this study was to confirm whether the expression of innate immune molecules in the chick cecum is altered in association with changes in the composition of the intestinal microbiome that are regulated by treatment with antibiotics. Broiler chicks were administered with antibiotics (penicillin and streptomycin) daily, and the composition of the microbiota, expression of innate immune molecules, and localization of antimicrobial peptides in the chick cecum were examined at day 7 and day 14 using real-time PCR and immunohistochemistry. The oral administration of antibiotics caused an increase in the relative frequency of the Enterobacteriaceae family and a decrease in some gram-negative (Barnesiellaceae) and gram-positive bacterial (Clostridiaceae and Erysipelotrichaceae) families. The gene expression levels of immune molecules, including 4 Toll-like receptors (TLR) (TLR 2, 4, 5, and 21), inflammation-related cytokines (IL-1β, TGFβ3, TGFβ4, and IL-8), and antimicrobial peptides (avian β-defensins and cathelicidins) showed a tendency to decrease with antibiotic treatment at day 7. However, expression levels of TLR21 and some cytokines (IL-1β, TGFβ3, and IL-8) were higher in the cecum or cecal tonsils of the antibiotic-treated group than in those of the control at day 14. The immunoreactive avian β-defensin 2 and cathelicidin 1 proteins were localized in the leukocyte-like cells in the lamina propria, and they were aggregated in the form of small islands. We conclude that the expression of innate immune molecules, including TLR, inflammation-related cytokines, and antimicrobial peptides, in the cecum are altered in association with changes in the density or composition of the luminal microbiota during the early phase of life in chicks.

Vertical Transmission of Gut Microbiome and Antimicrobial Resistance Genes in Infants Exposed to Antibiotics at Birth.

Vertical transmission of maternal microbes is a major route for establishing the gut microbiome in newborns. The impact of perinatal antibiotics on vertical transmission of microbes and antimicrobial resistance is not well understood. Using a metagenomic approach, we analyzed the fecal samples from mothers and vaginally delivered infants from a control group (10 pairs) and a treatment group (10 pairs) receiving perinatal antibiotics. Antibiotic-usage had a significant impact on the main source of inoculum in the gut microbiome of newborns. The control group had significantly more species transmitted from mothers to infants (P = .03) than the antibiotic-treated group. Approximately 72% of the gut microbial population of infants at 3–7 days after birth in the control group was transmitted from their mothers, versus only 25% in the antibiotic-treated group. In conclusion, perinatal antibiotics markedly disturbed vertical transmission and changed the source of gut colonization towards horizontal transfer from the environment to the infants.

Ceftriaxone Combined With Metronidazole is Superior to Cefoxitin Alone in the Management of Uncomplicated Appendicitis in Children: Results from a Multicenter Collaborative Comparative Effectiveness Study.

To compare rates of surgical site infection between the 2 most commonly utilized narrow-spectrum antibiotic regimens in children with uncomplicated appendicitis (ceftriaxone with metronidazole and cefoxitin alone). Narrow-spectrum antibiotics have been found to be equivalent to extended-spectrum (antipseudomonal) agents in preventing surgical site infection (SSI) in children with uncomplicated appendicitis. The comparative effectiveness of different narrow-spectrum agents has not been reported. This was a multicenter retrospective cohort study using clinical data from the Pediatric National Surgical Quality Improvement Program Appendectomy Collaborative Pilot database merged with antibiotic utilization data from the Pediatric Health Information System database from January 2013 to June 2015. Multivariable logistic regression was used to compare outcomes between antibiotic treatment groups after adjusting for patient characteristics, surrogate measures of disease severity, and clustering of outcomes within hospitals. Eight hundred forty-six patients from 14 hospitals were included in the final study cohort with an overall SSI rate of 1.3%. A total of 56.0% of patients received ceftriaxone with metronidazole (hospital range: 0%-100%) and 44.0% received cefoxitin (range: 0%-100%). In the multivariable model, ceftriaxone with metronidazole was associated with a 90% reduction in the odds of a SSI compared to cefoxitin [0.2% vs 2.7%; odds ratio: 0.10 (95% confidence interval 0.02-0.60); P = 0.01]. Ceftriaxone combined with metronidazole is superior to cefoxitin alone in preventing SSIs in children with uncomplicated appendicitis.

Evaluation of intravenous prophylaxis antibiotics for third molar extraction under general anesthesia.

Prophylactic antibiotic administration aims to maintain the postoperative wound environment. It is difficult to select appropriate prophylactic antibiotics to minimize the development of antibiotic resistant bacteria and the occurrence of complications. The purpose of this study was to compare the prophylactic effect of narrow spectrum antibiotics (cefazolin) with that of wide spectrum antibiotics (piperacillin) in preventing infection following third molar extraction. In addition, the effect of postoperative cefazolin administration was examined. This retrospective study included 350 patients who underwent third molar removal under general anesthesia. The patients were divided into three subgroups: preoperative cefazolin (N = 122), pre- and postoperative cefazolin (N = 101), and pre- and postoperative piperacillin (N = 127). The patients in the piperacillin group were administered the antibiotic preoperatively and postoperatively for 3days. The patients in the preoperative cefazolin group were administered cefazolin preoperatively only. The patients in the pre- and postoperative cefazolin group were administered cefazolin preoperatively and postoperatively for 1day. Surgical site infections (SSIs) were identified based on the Clavien-Dindo 30-day postoperative classification. There was a significant difference among the three groups of patients who had third molars classified as position C using the Pell and Gregory classification, according to the degree of impaction of the impacted third molar (P = 0.015). Our analysis showed that the number of SSI did not significantly differ between the three antibiotic treatment groups (P = 0.671). These results suggest that preoperative administration of cefazolin is as effective as postoperative administration of broad-spectrum antibiotics such as piperacillin.

Single and joint toxic effects of four antibiotics on some metabolic pathways of zebrafish (Danio rerio) larvae.

In China, antibiotics are commonly used for human and veterinary medicine, and they are present in various environmental media. Thus, the toxic effects of antibiotics on organisms have attracted the attention of society and scientists alike. In this study, zebrafish embryos were used to test the single and joint toxicity of four antibiotics, sulfamonomethoxine (SMM), cefotaxime sodium (CFT), tetracycline (TC), enrofloxacin (ENR), and their combinations, combining the results of experimental and omics techniques. Following exposure to antibiotics for 120h, the body lengths of zebrafish larvae in all 100μg/L antibiotic groups were significantly shortened, and the reactive oxygen species (ROS) content in the 100μg/L Mix group was significantly increased. Transcriptome sequencing (RNA-seq) showed that the mRNA level of numerous genes was significantly changed in the five antibiotic treatment groups. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis of the differentially expressed genes revealed a significant enrichment of the steroid biosynthesis and other metabolism pathways. Hub gene analysis highlighted dhcr24, acat1, aldh1a2, aldh8a1, suclg2, hadh, and hsdl2 as the key genes, and hub gene expression changes because of the antibiotic treatment suggested that the metabolic system of the zebrafish larvae was severely disrupted by the interaction with other genes. In conclusion, single or joint exposure to different antibiotics at environmental concentrations affected the early development and metabolic system of zebrafish larvae, and our results provide fundamental evidence for future studies of antibiotic toxicity in aquatic organisms.

Severe Infections and Antibiotic Use Negatively Impact Progression Free and Overall Survival of Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation

Background: The discovery that gut microbial dysbiosis correlated with prognosis, immune reconstitution and development of graft-versus-host disease (GVHD) in patients undergoing allogeneic stem cell transplantation (allo-SCT) highlights the clinical relevance of the gut microbiome in shaping anti-tumor immune responses. Treatment of allo-SCT patients with antibiotics has recently been associated with increased GVHD mortality (Routy et al. 2017). Based on these studies and the association of distinct gut bacteria with increased efficacy to PD-1 blockade in patients with solid tumors (Derosa et al. 2018), we performed a retrospective analysis to determine if infection treated with antibiotics affected the outcomes of multiple myeloma (MM) patients after autologous SCT (ASCT). Methods: A list of all MM patients treated at our institution between January 2012 through December 2015 was obtained and 1095 patients were identified. A comprehensive review of the electronic medical record (EMR) of the first 142 who received ASCT was performed. Information was collected from diagnosis to the date of last contact. Baseline characteristics, treatment history, transplant course, antibiotic treatment, and infection severity using common terminology criteria for adverse event (CTCAE) version 4 were reviewed. Prophylactic antibiotics were excluded. Response was measured and defined using the International Myeloma Working Group Criteria. Progression free survival (PFS) and overall survival (OS) were estimated using log rank tests. Cox hazard stepwise regression model examined for multiple factors affecting PFS and OS using the Akaike information criterion. Results: Of the 142 patients, 93 (65%) were Durie Salmon (DS) III, 20 (14%) were Revised International Staging System (R-ISS) III, 44 (31%) had high-risk cytogenetics, and 76 (54%) were male. The median age at diagnosis was 60. Although there was a similar frequency of DS III (67% vs 61%) and high-risk cytogenetics (35% vs 25%) among patients in the antibiotic and non-antibiotic treated groups, there was an over-representation of R-ISS 3 (19% v 4%) patients in the antibiotic-treated group. Treatment with antibiotics was associated with decreased median PFS (2.38 vs 6.58 years (yrs), p =0.00003) (Figure 1a) and decreased median OS (7.43 vs 17.39 yrs, p = &lt;0.0001). Fluoroquinolone use compared to no fluoroquinolone use was associated with decreased PFS (1.91 vs 4.09 yrs, p = 0.0001) (Figure 1b) as well as a trend toward decreased OS (7.01 vs 14.23 yrs, p = 0.1). Beta-lactam use compared to no beta-lactam use was associated with decreased PFS (1.74 vs 4.34 yrs, p = &lt;0.0001) (Figure 1c) as well as decreased OS (7.01 vs 17.39 yrs, p = 0.0004). Maximal CTCAE grade of infection throughout the treatment course was a further predictor of decreased PFS-no infection vs CTCAE grade 1/2 vs CTCAE 3/4 (7.49 vs 3.77 vs 1.92 yrs, p = &lt;0.0001) (Figure 2) and OS-no infection vs CTCAE 3/4 (17.39 vs 6.58 yrs, p = &lt;0.0001). (Figure 2). Multivariate analysis demonstrated progression risk associated with beta-lactam use (HR-2.25, 95% CI, 1.31 - 3.85, p = 0.003), and DSS III (HR-2.28, 95% CI, 1.23 - 4.21, p = 0.009). Multivariate analysis demonstrated increased mortality associated with antibiotic treatment (HR-5.70, 95% CI, 1.34 - 34.29, p = 0.019) and decreased mortality risk with age younger than 65 (HR-0.24, 95% CI, 0.07 - 0.81, p = 0.022). For both PFS and OS, there was no statistical significance demonstrated in multivariate analysis for gender, fluoroquinolone treatment, high risk cytogenetics, R-ISS 3, or CTCAE grade. Conclusion: In this preliminary study, antibiotic use and infection severity predicted for decreased PFS and OS compared to patients who did not receive antibiotics in MM patients undergoing ASCT. Treatment with at least 2 classes of antibiotics-fluoroquinolones and beta-lactams, predicted for decreased PFS and OS. Multivariate analysis showed increased progression risk with beta lactams and DSS III as well as increased mortality risk with antibiotic treatment and advanced age. The study was limited by its relatively small sample size, retrospective nature, and the high correlation among infection and antibiotic groups that affected the multivariate analysis. Work is underway at our institution to further elucidate the impact of antibiotics on microbial diversity and patient survival. Disclosures Goldberg: COTA: Equity Ownership; Bristol-Myers Squibb: Consultancy; Cancer Outcomes Tracking and Analysis (COTA) Inc.: Equity Ownership. Rowley:Allergan: Equity Ownership; Fate Therapeutics: Consultancy. Siegel:Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Bristol-Myers Squibb Company: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau. Biran:Merck: Research Funding; Janssen: Consultancy, Honoraria, Research Funding; Amgen: Consultancy, Honoraria, Research Funding; Celgene: Consultancy, Honoraria; Takeda: Consultancy, Honoraria; Bristol Meyers Squibb: Research Funding.

Exploration of the death causes in zoea stages of Macrobrachium rosenbergii based on microbial diversity analysis

To investigate the cause of low survival rates of Macrobrachium rosenbergii zoea in a breeding farm, traditional bacterial isolation, culture, and infection experiments were carried out. Survival rates were determined after antibacterial (oxytetracycline) bathing and disinfectant (formalin and allicin) treatments. The microbiota alterations of M. rosenbergii zoea after antibacterial bathing (zoea antibiotic treatment group and berried female antibiotic treatment group) and disinfectant treatments were identified. The results showed the presence of 42 strains of dominant bacteria that were isolated from the zoea; four strains belonging to the genus Vibrio were randomly selected and shown to have different degrees of pathogenicity, indicating mixed infection of Vibrio pathogens in the M. rosenbergii zoea. The use of an antibacterial drug and disinfectant significantly increased survival rates, indicating that bacterial infection was the main cause of the low survival rates of the M. rosenbergii zoea in this farm. High throughput sequencing results showed a decrease of bacterial diversity of the M. rosenbergii zoea after disinfectant treatment (p ≤ 0.05). The relative abundances of the dominant genera (>5%) were as follows: Vibrio was most abundant in the control group (33.52%), whereas values were low in the drug treatment group (zoea 4.9%, berried female 4.6%) and disinfectant group (<0.01). Enterobacter in the corresponding groups were 25.91%, 13.48% 10.11% and 60.86%, respectively; Bacillus values were 15.93%, 38%, and 40% in the control group and antibiotic bath treatment group (zoea and berried female), respectively, and were significantly higher than that in the disinfectant group (<5%). Lactococcus in the corresponding groups were 4.4%, 9.22%, 10.13%, and 12.44%, respectively. LEfSe analysis also indicated that Vibrio, Bacillus, and Enterobacter abundances varied significantly among different groups. In addition, the clustering and PCoA analyses showed that oxytetracycline and disinfectants have different effects on the microflora structure of M. rosenbergii zoea.