The effect of short-course antibiotics on the resistance profile of colonizing gut bacteria in the ICU: a prospective cohort study
| العنوان: | The effect of short-course antibiotics on the resistance profile of colonizing gut bacteria in the ICU: a prospective cohort study |
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| المؤلفون: | Ravi U. Sheth, Julian A. Abrams, Jessica Weidler, Daniel E. Freedberg, Philip Zachariah, Stephania Stump, Edward Cuaresma, Christian Munck, Anne-Catrin Uhlemann, David H. Chong, Harris H. Wang |
| المصدر: | Critical Care, Vol 24, Iss 1, Pp 1-10 (2020) Critical Care |
| بيانات النشر: | Research Square Platform LLC, 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Male, Colonization, medicine.medical_specialty, Time Factors, medicine.drug_class, Antibiotics, Antimicrobial resistance, Critical Care and Intensive Care Medicine, medicine.disease_cause, law.invention, Cohort Studies, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Antibiotic resistance, law, Internal medicine, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Healthcare-associated infection, Prospective cohort study, Aged, 030304 developmental biology, 0303 health sciences, biology, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, lcsh:RC86-88.9, Middle Aged, medicine.disease, biology.organism_classification, Intensive care unit, Anti-Bacterial Agents, Gastrointestinal Microbiome, Intensive Care Units, Enterococcus, Staphylococcus aureus, Vancomycin, Female, business, medicine.drug |
| الوصف: | Background The need for early antibiotics in the intensive care unit (ICU) is often balanced against the goal of antibiotic stewardship. Long-course antibiotics increase the burden of antimicrobial resistance within colonizing gut bacteria, but the dynamics of this process are not fully understood. We sought to determine how short-course antibiotics affect the antimicrobial resistance phenotype and genotype of colonizing gut bacteria in the ICU by performing a prospective cohort study with assessments of resistance at ICU admission and exactly 72 h later. Methods Deep rectal swabs were performed on 48 adults at the time of ICU admission and exactly 72 h later, including patients who did and did not receive antibiotics. To determine resistance phenotype, rectal swabs were cultured for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). In addition, Gram-negative bacterial isolates were cultured against relevant antibiotics. To determine resistance genotype, quantitative PCR (qPCR) was performed from rectal swabs for 87 established resistance genes. Within-individual changes in antimicrobial resistance were calculated based on culture and qPCR results and correlated with exposure to relevant antibiotics (e.g., did β-lactam antibiotic exposure associate with a detectable change in β-lactam resistance over this 72-h period?). Results Of 48 ICU patients, 41 (85%) received antibiotics. Overall, there was no increase in the antimicrobial resistance profile of colonizing gut bacteria during the 72-h study period. There was also no increase in antimicrobial resistance after stratification by receipt of antibiotics (i.e., no detectable increase in β-lactam, vancomycin, or macrolide resistance regardless of whether patients received those same antibiotics). This was true for both culture and PCR. Antimicrobial resistance pattern at ICU admission strongly predicted resistance pattern after 72 h. Conclusions Short-course ICU antibiotics made little detectable difference in the antimicrobial resistance pattern of colonizing gut bacteria over 72 h in the ICU. This provides an improved understanding of the dynamics of antimicrobial resistance in the ICU and some reassurance that short-course antibiotics may not adversely impact the stewardship goal of reducing antimicrobial resistance. |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ff049143ec4479fef984cc47a90f147bTest https://doi.org/10.21203/rs.2.23155/v2Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....ff049143ec4479fef984cc47a90f147b |
| قاعدة البيانات: | OpenAIRE |
| الوصف غير متاح. |