Does antibiotic use explain the discrepancy of urolithiasis prevalence between countries?
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LETTER TO THE EDITOR
Does antibiotic use explain the discrepancy of urolithiasis prevalence between countries? Aya Karam1 · Georges Mjaess1 · Fouad Aoun1,2 · Simone Albisinni3 · Haydeh Vafa4 · Thierry Roumeguere2,3 Received: 26 October 2020 / Accepted: 3 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, We have read with great interest the manuscript published by Rodríguez et al. [1]. The authors have shown in their prospective study that patients with calcium oxalate urinary lithiasis have a reduced number of bacteria in their gut microbiota, and this due to a chronic intestinal dysbiosis [1]. The prevalence of urolithiasis varies widely among world countries. This worldwide discrepancy is explained by a variety of influencing factors such as genetic factors, dietary habits, climate, daily water intake, physical activity and obesity. Recently, the human gut microbiota has been proven to play a pivotal role in the pathophysiology of idiopathic calcium oxalate nephrolithiasis, the most common kidney stone. Some of the gut microbiota (such as Oxalobacter, Bifidobacterium, Escherichia, Lactobacillus, and Eubacterium), and more specifically Oxalobacter formigenes, can degrade oxalate, enhancing enteric oxalate secretion, resulting in a decrease in intestinal oxalate absorption and thus, reduction in urinary oxalate excretion [2]. Intestinal colonization with these bacteria is associated with a significant reduction in the risk of recurrence of calcium oxalate stones [2].
* Georges Mjaess [email protected] 1
Hotel‑Dieu de France, University of Saint Joseph, Beirut, Lebanon
2
Department of Urology, Institut Jules Bordet, Brussels, Belgium
3
Department of Urology, University Clinics of Brussels, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
4
Department of Gastro‑Enterology, University Clinics of Brussels, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
Furthermore, it has been postulated that nephrolithiasis was associated with gut and urinary microbiota dysbiosis, and, therefore, could depend on increased exposure to antibiotic therapy. Lifetime exposure to the widely prescribed antibiotics (broad-spectrum penicillins, cephalosporins, fluoroquinolones, nitrofurantoin and sulfa drugs), particularly long-course treatment occurring during younger age, alters intestinal and urinary microbiota, and, therefore, is one of the factors promoting urinary lithiasis. Based on these findings, we aimed to investigate if the worldwide discrepancy of urolithiasis prevalence among countries is influenced by the rate of antibiotic consumption in each country. We have thus reviewed the WHO report on surveillance of antibiotic consumption [3] to depict the Defined Daily Doses (DDD) of antibiotics per 1000 inhabitants per day for each country. In parallel, we have searched the literature for the existing data for prevalence of urolithiasis in different countries (Fig. 1). We then assessed the correlation between the DDD of antibiotics
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