Omadacycline Gut Microbiome Exposure Does Not InduceClostridium difficileProliferation or Toxin Production in a Model That Simulates the Proximal, Medial, and Distal Human Colon
ABSTRACTA clinically reflective model of the human colon was used to investigate the effects of the broad-spectrum antibiotic omadacycline on the gut microbiome and the subsequent potential to induce simulatedClostridium difficileinfection (CDI). Triple-stage chemostat gut models were inoculated with pooled human fecal slurry from healthy volunteers (age, ≥60 years). Models were challenged twice with 107CFUC. difficilespores (PCR ribotype 027). Omadacycline effects were assessed in a single gut model. Observations were confirmed in a parallel study with omadacycline and moxifloxacin. Antibiotic instillation was performed once daily for 7 days. The models were observed for 3 weeks postantibiotic challenge. Gut microbiota populations andC. difficiletotal viable and spore counts were enumerated daily by culture. Cytotoxin titers and antibiotic concentrations were also measured. Gut microbiota populations were stable before antibiotic challenge. Moxifloxacin instillation caused an ∼4 log10CFU/ml decline in enterococci andBacteroides fragilisgroup populations and an ∼3 log10CFU/ml decline in bifidobacteria and lactobacilli, followed by simulated CDI (vegetative cell proliferation and detectable toxin). In both models, omadacycline instillation decreased populations of bifidobacteria (∼8 log10CFU/ml),B. fragilisgroup populations (7 to 8 log10CFU/ml), lactobacilli (2 to 6 log10CFU/ml), and enterococci (4 to 6 log10CFU/ml). Despite these microbial shifts, there was no evidence ofC. difficilebacteria germination or toxin production. In contrast to moxifloxacin, omadacycline exposure did not facilitate simulated CDI, suggesting this antibiotic may have a low propensity to induce CDI in the clinical setting.