Reducing Broad-Spectrum Antibiotic Treatment of Simple Group A Streptococcal Infections to Reduce Harm to the Microbiome

BACKGROUNDAntibiotic treatment for asymptomatic bacteriuria (ASB) is prevalent but often contrary to published guidelines.OBJECTIVETo evaluate risk factors for treatment of ASB.DESIGNRetrospective observational study.SETTINGA tertiary academic hospital, county hospital, and community hospital.PATIENTSHospitalized adults with bacteriuria.METHODSPatients without documented symptoms of urinary tract infection per Infectious Diseases Society of America (IDSA) criteria were classified as ASB. We examined ASB treatment risk factors as well as broad-spectrum antibiotic usage and quantified diagnostic concordance between IDSA and National Healthcare Safety Network criteria.RESULTSAmong 300 patients with bacteriuria, ASB was present in 71% by IDSA criteria. By National Healthcare Safety Network criteria, 71% of patients had ASB; within-patient diagnostic concordance with IDSA was moderate (kappa, 0.52). After excluding those given antibiotics for nonurinary indications, antibiotics were given to 38% (62/164) with ASB. Factors significantly associated with ASB treatment were elevated urine white cell count (65 vs 24 white blood cells per high-powered field, P<.01), hospital identity (hospital C vs A, odds ratio, 0.34 [95% CI, 0.14–0.80], P =.01), presence of leukocyte esterase (5.48 [2.35–12.79], P<.01), presence of nitrites (2.45 [1.11–5.41], P=.03), and Escherichia coli on culture (2.4 [1.2–4.7], P=.01). Of patients treated for ASB, broad-spectrum antibiotics were used in 84%.CONCLUSIONSASB treatment was prevalent across settings and contributed to broad-spectrum antibiotic use. Associating abnormal urinalysis results with the need for antibiotic treatment regardless of symptoms may drive unnecessary antibiotic use.Infect. Control Hosp. Epidemiol. 2016;37(3):319–326

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A Pathogen-Selective Antibiotic Minimizes Disturbance to the Microbiome

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00535-16 ◽

2016 ◽

Vol 60 (7) ◽

pp. 4264-4273 ◽

Cited By ~ 22

Author(s):

Jiangwei Yao ◽

Robert A. Carter ◽

Grégoire Vuagniaux ◽

Maryse Barbier ◽

Jason W. Rosch ◽

...

Keyword(s):

Antibiotic Treatment ◽

Broad Spectrum ◽

Gut Microbiome ◽

Bacterial Abundance ◽

Acyl Carrier Protein ◽

Control Group ◽

Oral Antibiotics ◽

Broad Spectrum Antibiotic ◽

Microbial Composition ◽

Selective Approach

ABSTRACTBroad-spectrum antibiotic therapy decimates the gut microbiome, resulting in a variety of negative health consequences. Debio 1452 is a staphylococcus-selective enoyl-acyl carrier protein reductase (FabI) inhibitor under clinical development and was used to determine whether treatment with pathogen-selective antibiotics would minimize disturbance to the microbiome. The effect of oral Debio 1452 on the microbiota of mice was compared to the effects of four commonly used broad-spectrum oral antibiotics. During the 10 days of oral Debio 1452 treatment, there was minimal disturbance to the gut bacterial abundance and composition, with only the unclassified S24-7 taxon reduced at days 6 and 10. In comparison, broad-spectrum oral antibiotics caused ∼100- to 4,000-fold decreases in gut bacterial abundance and severely altered the microbial composition. The gut bacterial abundance and composition of Debio 1452-treated mice were indistinguishable from those of untreated mice 2 days after the antibiotic treatment was stopped. In contrast, the bacterial abundance in broad-spectrum-antibiotic-treated mice took up to 7 days to recover, and the gut composition of the broad-spectrum-antibiotic-treated mice remained different from that of the control group 20 days after the cessation of antibiotic treatment. These results illustrate that a pathogen-selective approach to antibiotic development will minimize disturbance to the gut microbiome.

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Megaloblastic anemia: A common but often neglected cause of pyrexia of unknown origin

Journal of Translational Internal Medicine ◽

10.1515/jtim-2015-0005 ◽

2015 ◽

Vol 3 (2) ◽

pp. 64-67 ◽

Cited By ~ 1

Author(s):

Bushra Siddiqui ◽

Divya Rabindranath ◽

Shahbaz Habib Faridi ◽

Azka Anees Khan ◽

Sadaf Haiyat ◽

...

Keyword(s):

Vitamin B12 ◽

Antibiotic Treatment ◽

Broad Spectrum ◽

Marked Improvement ◽

Megaloblastic Anemia ◽

Unknown Origin ◽

Epidemiological Data ◽

Broad Spectrum Antibiotic ◽

Pyrexia Of Unknown Origin ◽

Intravenous Antibiotics

AbstractObjective: The objective was to study megaloblastic anemia as a cause of pyrexia of unknown origin (PUO). Materials and Methods: We conducted a study on 15 patients of megaloblastic anemia associated with fever, attending our hospital clinics over a period of 6 months. Results: While 11 patients had symptoms suggesting foci of infection and responded well to intravenous antibiotics, 4 patients had neither any evidence of infection nor responded with empirical broad spectrum antibiotic treatment. They were treated with vitamin B12/folate therapy which led to marked improvement in fever within 48 h. Presenting complaints of the patients and severity/duration of fever along with other epidemiological data were also studied in each case. Conclusion: The present study led us to conclude that megaloblastic anemia forms an important and reversible cause of fever and should be ruled out in all patients presenting with PUO. This knowledge would help the physicians in adequate and timely management of these patients.

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Fecal Microbiota Transplantation, Commensal Escherichia coli and Lactobacillus johnsonii Strains Differentially Restore Intestinal and Systemic Adaptive Immune Cell Populations Following Broad-spectrum Antibiotic Treatment

Frontiers in Microbiology ◽

10.3389/fmicb.2017.02430 ◽

2017 ◽

Vol 8 ◽

Cited By ~ 20

Author(s):

Ira Ekmekciu ◽

Eliane von Klitzing ◽

Christian Neumann ◽

Petra Bacher ◽

Alexander Scheffold ◽

...

Keyword(s):

Escherichia Coli ◽

Antibiotic Treatment ◽

Broad Spectrum ◽

Immune Cell ◽

Fecal Microbiota Transplantation ◽

Fecal Microbiota ◽

Cell Populations ◽

Lactobacillus Johnsonii ◽

Broad Spectrum Antibiotic ◽

Adaptive Immune

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Immune Responses to Broad-Spectrum Antibiotic Treatment and Fecal Microbiota Transplantation in Mice

Frontiers in Immunology ◽

10.3389/fimmu.2017.00397 ◽

2017 ◽

Vol 8 ◽

Cited By ~ 44

Author(s):

Ira Ekmekciu ◽

Eliane von Klitzing ◽

Ulrike Fiebiger ◽

Ulrike Escher ◽

Christian Neumann ◽

...

Keyword(s):

Immune Responses ◽

Antibiotic Treatment ◽

Broad Spectrum ◽

Fecal Microbiota Transplantation ◽

Fecal Microbiota ◽

Broad Spectrum Antibiotic

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Ridinilazole, a narrow spectrum antibiotic for treatment of Clostridioides difficile infection, enhances preservation of microbiota-dependent bile acids

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00046.2020 ◽

2020 ◽

Vol 319 (2) ◽

pp. G227-G237 ◽

Cited By ~ 1

Author(s):

Xi Qian ◽

Karin Yanagi ◽

Anne V. Kane ◽

Nicholas Alden ◽

Ming Lei ◽

...

Keyword(s):

Bile Acid ◽

Antibiotic Treatment ◽

Broad Spectrum ◽

Acid Metabolism ◽

Bile Acid Metabolism ◽

Treatment Cessation ◽

Broad Spectrum Antibiotic ◽

Narrow Spectrum ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection

This is the first study to demonstrate in humans the relationships between Clostridioides difficile antibiotic treatment choice and bile acid metabolism both during therapy and after treatment cessation. The results show a microbiota- and metabolome-preserving property of a novel narrow-spectrum agent that correlates with the agent’s favorable sustained clinical response rates compared with broad-spectrum antibiotic treatment.

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