Antibacterials
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Gut dysbiosis: case report In a report, a female patient [exact age at the time of reaction onset not stated] developed gut dysbiosis during antibacterial treatment with unspecified chemotherapy agents for acute leukaemia and antibacterials including cefepime, metronidazole, levofloxacin, azithromycin, vancomycin, amikacin, ciprofloxacin, cotrimoxazole and meropenem [not all routes and dosages stated; time to reactions onset not stated]. The female patient, who was diagnosed with acute leukaemia, underwent three phases of therapy. The first phase was AL1 (first induction chemotherapy) along with antibacterials including cefepime for 20 days, metronidazole for 13 days, levofloxacin for 11 days, azithromycin for 6 days, IV vancomycin for 3 days. In the 33 days between AL1 ending and haematopoietic cell transplantation (HCT; second phase) beginning, a nine day course of levofloxacin was administered. The second phase HCT included antibacterial therapy with IV vancomycin for 9 days, cefepime for 8 days, levofloxacin for 7 days, amikacin for 3 days and meropenem for 3 days. She remained in remission for approximately one year after HCT, during which she received six different types of antibacterials including cotrimoxazole [trimethoprim/sulfamethoxazole] for 24 days, levofloxacin for 20 days, meropenem for 14 days, cefepime for 5 days, amikacin for 4 days, ciprofloxacin for 4 days. The third phase AL2 (second induction chemotherapy) along with antibacterials including cefepime for 24 days, levofloxacin for 7 days, IV vancomycin for 3 days and azithromycin for 1 day. Stool samples were collected and studied during each phase of therapy. The first sample collected in the AL1 phase was used as source sample for all subsequent samples (sink). The microbiome was found to be 100% dissimilar to its baseline by the end of AL1 phase. During the 9 day course of levofloxacin, the sample collected suggested partial resilience. The microbiome similarity to baseline further decreased during HCT, which was further only 13% similar by the end of HCT. During the remission period, stool sample collected showed little microbiome compositional recovery with an increase of 16% similarity to baseline. The finding were suggestive of a possibly permanent compositional alteration. At the end of AL2, the microbiome was found to be 90% dissimilar. The findings were suggestive of gut dysbiosis which was partially reversible after the first insult but likely irreversible after the second insult and settled into a new steady state by the end of third insult. The woman received total parenteral nutrition and enteral nutrition during HCT and AL2. She had various concurrent conditions during the three phases of therapy. She died due to fulminant clostridium difficile colitis secondary to gut dysbiosis. Rashidi A, et al. Microbiome swings with repeated insults. British Journal of Haematology 189: e94-e96, No. 3, May 2020. Available from: URL: http://doi.org/10.1111/ 803516145 bjh.16509
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