住院期间使用抗生素治疗时使用益生菌是否能预防肠道微生物群定植多重耐药菌?一项比较 与 和 的随机安慰剂对照试验
Do Probiotics During In-Hospital Antibiotic Treatment Prevent Colonization of Gut Microbiota With Multi-Drug-Resistant Bacteria? A Randomized Placebo-Controlled Trial Comparing to a Mixture of , and .
机构信息
Service of Internal Medicine, Clinique Saint Pierre, Ottignies-Louvain-la-Neuve, Belgium.
Service of Microbiology, Clinique Saint Pierre, Ottignies-Louvain-la-Neuve, Belgium.
出版信息
Front Public Health. 2021 Mar 8;8:578089. doi: 10.3389/fpubh.2020.578089. eCollection 2020.
Most infections with producing AmpC β-lactamase (AmpC)-, extended-spectrum β-lactamase (ESBL)-, and carbapenemase-producing bacteria, vancomycin-resistant as well as naturally resistant non-fermenting bacteria such as , are related to a prior colonization of the gut microbiota. The objective of this study was to determine whether treatment with probiotics during an antibiotic treatment could prevent the colonization of the gut microbiota with multi-drug resistant bacteria. In total, 120 patients treated for 10 days with amoxicillin-clavulanate antibiotics were included in a randomized, placebo-controlled, double-blinded trial, comparing the effects of a 30 days treatment with placebo CNCM I-745® and a probiotic mixture containing NCFM, Lpc-37, Bl-04, and Bi-07 (Bactiol duo®). Study treatment was initiated within 48 h of the antibiotic being initiated. Most of the patients included were elderly with a mean age of 78 years old with multiple comorbidities. Stools were collected at the time of inclusion in the trial, at the end of the antibiotic treatment, and the end of the study treatment. These were cultured on selective antibiotic media. Treatment with the probiotic mixture led to a significant decline in colonization with after antibiotic treatment from 25 to 8.3% ( = 0.041). Colonization with AmpC-producing enterobacteria was transiently increased after the antibiotic treatment ( = 0.027) and declined after the probiotic intervention (p= 0.041). No significant changes were observed in the placebo and groups. Up to 2 years after the trial, no infection with ESBL-producing bacteria was observed in the probiotic mixture group. The association of with specific strains of and influences antibiotic treatment by counteracting the colonization of the colon microbiota with antibiotic-resistant pathogens.
大多数产 AmpC β-内酰胺酶(AmpC)、超广谱β-内酰胺酶(ESBL)和碳青霉烯酶的细菌、耐万古霉素的 和天然耐药的非发酵菌(如 )感染与肠道微生物群的先前定植有关。本研究的目的是确定在抗生素治疗期间使用益生菌治疗是否可以防止肠道微生物群被多药耐药菌定植。共有 120 名接受阿莫西林-克拉维酸抗生素治疗 10 天的患者参与了一项随机、安慰剂对照、双盲试验,比较了 30 天安慰剂(CNCM I-745®)和含有 NCFM、Lpc-37、Bl-04 和 Bi-07(Bactiol duo®)的益生菌混合物治疗的效果。研究治疗在抗生素开始后 48 小时内开始。大多数纳入的患者为老年人,平均年龄为 78 岁,合并多种合并症。在试验纳入时、抗生素治疗结束时和研究治疗结束时采集粪便。这些样本在选择性抗生素培养基上进行培养。使用益生菌混合物治疗可显著降低抗生素治疗后 定植,从 25%降至 8.3%( = 0.041)。抗生素治疗后 AmpC 产肠杆菌的定植短暂增加( = 0.027),益生菌干预后下降(p= 0.041)。安慰剂和 组未观察到显著变化。在试验结束后 2 年内,益生菌混合物组未观察到产 ESBL 细菌感染。 与特定的 菌株和 相关联会影响抗生素治疗,通过拮抗抗生素耐药病原体对结肠微生物群的定植。