Antibiotics’ collateral effects on the gut microbiota in the selection of ESKAPE pathogens
Background: ESKAPE pathogens, consisting of Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp., labelled high-priority by WHO, evade antibiotics, posing treatment challenges and escalating healthcare costs. The g...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-11-01
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| Series: | CMI Communications |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S295059092400012X |
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| Summary: | Background: ESKAPE pathogens, consisting of Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp., labelled high-priority by WHO, evade antibiotics, posing treatment challenges and escalating healthcare costs. The gut microbiome is a well-established reservoir of ESKAPE pathogens and resistance determinants. Objectives: This narrative review aims to provide prescribers with insights into the effects of antibiotics on the gut microbiome, focusing on ESKAPE pathogens. Additionally, it highlights key knowledge gaps and future research directions. Sources: A literature review was performed in Pubmed using terms related to ESKAPE, antibiotic treatment, colonization or microbiome. Relevant clinical-epidemiological and molecular studies were included and a narrative synthesis was conducted. Content: Antibiotic treatment rapidly diminishes microbiome diversity, taking up to six months for partial recovery, leading to an imbalance favouring opportunistic pathogens. Different antibiotics exert varying impacts on microbiome diversity and composition. They also influence ESKAPE pathogen colonization differently, with antibiotic use being a significant risk factor for ESKAPE colonization and infection.Moreover, antibiotic treatment enriches the gut resistome, escalating antimicrobial resistance gene abundance. Specific antibiotics can differently affect resistome development. Resistant bacteria gut colonization can persist post-antibiotic treatment, accentuating antibiotic resistance challenges. Implications: The significant and sustained impact of antibiotic substances on the gut microbiota and the selection of ESKAPE pathogens underlines the importance of antibiotic stewardship interventions to reduce antibiotic exposure. Understanding the complex interplay between antibiotics and gut microbiota is crucial for optimizing antibiotic use and combating antibiotic resistance. Further research is needed to longitudinally assess the effects of specific antibiotics on ESKAPE pathogen colonization patterns and resistance gene enrichment, as well as to evaluate the effect of antibiotic stewardship strategies in clinical practice. This knowledge can affect our daily practice in prescription of antibiotics to minimize the spread of antibiotic resistance |
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| ISSN: | 2950-5909 |