Stool and sputum microbiome during quinolone prophylaxis of spontaneous bacterial peritonitis: an exploratory study
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ut Pathogens Open Access
RESEARCH
Stool and sputum microbiome during quinolone prophylaxis of spontaneous bacterial peritonitis: an exploratory study Marcus M. Mücke1* , Sabrina Rüschenbaum1,2, Amelie Mayer1, Victoria T. Mücke1, Katharina M. Schwarzkopf1, Stefan Zeuzem1, Jan Kehrmann3†, René Scholtysik4† and Christian M. Lange1,2†
Abstract Introduction: Quinolone prophylaxis is recommended for patients with advanced cirrhosis at high risk of spontaneous bacterial peritonitis (SBP) or with prior SBP. Yet, the impact of long-term antibiotic prophylaxis on the microbiome of these patients is poorly characterized. Methods: Patients with liver cirrhosis receiving long-term quinolone prophylaxis to prevent SBP were prospectively included and sputum and stool samples were obtained at baseline, 1, 4 and 12 weeks thereafter. Both bacterial DNA and RNA were assessed with 16S rRNA sequencing. Relative abundance, alpha and beta diversity were calculated and correlated with clinical outcome. Results: Overall, 35 stool and 19 sputum samples were obtained from 11 patients. Two patients died (day 9 and 12) all others were followed for 180 days. Reduction of Shannon diversity and bacterial richness was insignificant after initiation of quinolone prophylaxis (p > 0.05). Gut microbiota were significantly different between patients (p 0.05). A high relative abundance of Enterobacteriaceae > 20% during quinolone prophylaxis was found in three patients. Specific clinical scenarios (development of secondary infections during antibiotic prophylaxis or the detection of multidrug-resistant Enterobacteriaceae) characterized these patients. Sputum microbiota were not significantly altered in individuals during prophylaxis. Conclusion: The present exploratory study with small sample size showed that inter-individual differences in diversity of gut microbiota were high at baseline, yet quinolone prophylaxis had only a moderate impact. High relative abundances of Enterobacteriaceae during follow-up might indicate failure of or non-adherence to quinolone prophylaxis. However, our results may not be clinically significant given the limitations of the study and therefore future studies are needed to further investigate this phenomenon. Keywords: Quinolones, Multidrug-resistance, Infections, Bacterial abundance, Enterobacteriaceae
*Correspondence: [email protected] † Jan Kehrmann, René Scholtysik and Christian M. Lange contributed equally to this manuscript 1 Present Address: Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor‑Stern‑Kai 7, 60590 Frankfurt am Main, Germany Full list of author information is available at the end of the article
Introduction Infections in cirrhosis often lead to acute decompensation (AD) or acute-on-chronic liver failure (ACLF) and have been associated with increased morbidity and mortality [1, 2]. The most common infections in cirrhosis are spontaneous bacterial peritonitis (SBP), urinary tract infections and pneumonia [2, 3]. The bacteria causing SBP and numerous
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