Department of Paediatrics, Fribourg Hospital HFR and Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.
Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
Arch Dis Child Fetal Neonatal Ed. 2020 Mar;105(2):201-208. doi: 10.1136/archdischild-2018-316659. Epub 2019 Jul 11.
The use of intrapartum antibiotic prophylaxis (IAP) has become common practice in obstetric medicine and is used in up to 40% of deliveries. Despite its benefits, the risks associated with exposing large numbers of infants to antibiotics, especially long-term effects on health through changes in the microbiota, remain unclear. This systematic review summarises studies that have investigated the effect of IAP on the intestinal microbiota of infants.
A systematic search in Ovid MEDLINE was used to identify original studies that investigated the effect of IAP on the intestinal microbiota in infants. Studies were excluded if: they included preterm infants, the antibiotic regimen was not specified, antibiotics were used for indications other than prophylaxis, probiotics were given to mothers or infants, or antibiotics were given to infants.
We identified six studies, which investigated a total of 272 infants and included 502 stool samples collected up to 3 months of age. In all the studies, IAP was given for group B streptococcus (GBS) colonisation. Infants who were exposed to GBS IAP had a lower bacterial diversity, a lower relative abundance of Actinobacteria, especially , and a larger relative abundance of Proteobacteria in their intestinal microbiota compared with non-exposed infants. Conflicting results were reported for the phyla Bacteroidetes and Firmicutes.
GBS IAP has profound effects on the intestinal microbiota of infants by diminishing beneficial commensals. Such changes during the early-life 'critical window' during which the intestinal microbiota and the immune response develop concurrently may have an important influence on immune development. The potential long-term adverse consequences of this on the health of children warrant further investigation.
在产科医学中，产时抗生素预防（IAP）已被广泛应用，高达 40%的分娩都使用了该方法。尽管它有很多益处，但大量婴儿暴露于抗生素的风险，特别是通过改变微生物群对健康的长期影响，仍不清楚。本系统综述总结了研究 IAP 对婴儿肠道微生物群影响的研究。
使用 Ovid MEDLINE 进行系统检索，以确定调查 IAP 对婴儿肠道微生物群影响的原始研究。如果研究包括早产儿、抗生素方案未具体说明、抗生素用于预防以外的指征、给母亲或婴儿使用益生菌、或给婴儿使用抗生素，则将其排除在外。
我们确定了六项研究，共纳入 272 名婴儿，共采集了 502 份粪便样本，采集时间截至婴儿 3 个月大。在所有研究中，IAP 都是针对 B 组链球菌（GBS）定植而使用的。与未暴露的婴儿相比，暴露于 GBS IAP 的婴儿的肠道微生物群的细菌多样性较低，放线菌（尤其是 ）的相对丰度较低，而变形菌的相对丰度较高。厚壁菌门和Firmicutes 门的结果存在冲突。
GBS IAP 通过减少有益共生菌对婴儿的肠道微生物群产生深远影响。在肠道微生物群和免疫反应同时发育的生命早期“关键窗口期”期间发生这种变化，可能对免疫发育产生重要影响。这种变化对儿童健康的潜在长期不良后果需要进一步研究。
