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The neonatal intestinal resistome and factors that influence it-a systematic review
Stefano Leo1, Nigel Curtis2, Petra Zimmermann3
1Department for Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland; Department of Paediatrics, Fribourg Hospital, Fribourg, Switzerland.
Insights
The neonatal gut microbiome contains many antibiotic resistance genes (ARGs), even without direct antibiotic exposure. Factors like breastfeeding and probiotics can reduce ARGs, while antibiotics increase them.
Area of Science:
- Microbiology
- Genetics
- Neonatal Health
Background:
- The intestinal microbiome is a reservoir for antibiotic resistance genes (ARGs).
- The neonatal microbiome is particularly vulnerable to external disturbances.
- Understanding the neonatal resistome is crucial for public health.
Approach:
- Systematic review of studies investigating neonatal intestinal resistome.
- Searched MEDLINE and Embase databases.
- Included original studies using molecular diagnostics on neonatal stool or rectal swabs.
Key Points:
- Neonatal intestines harbor a high abundance and diversity of ARGs, independent of direct antibiotic exposure.
- Common ARGs confer resistance to aminoglycosides, β-lactams, macrolides, tetracyclines, and multidrug resistance.
- ARGs can transfer from mothers to neonates, with neonates exhibiting higher abundance, potentially due to abundant Gammaproteobacteria.
Conclusions:
- Neonates may have reduced colonization resistance, facilitating the establishment of antibiotic-resistant populations.
- Antibiotic use in neonates and mothers increases ARG abundance, while breastfeeding and probiotics decrease it.
- Future interventions, including pre/probiotics and bacteriophages, could modulate neonatal ARG abundance.
Background:
The intestinal microbiome provides a reservoir for antibiotic resistance genes (ARGs). The neonatal microbiome is more susceptible to disturbance from external factors than the established microbiome in later life.
Objectives:
In this review, we systematically summarize studies which investigated the intestinal resistome in neonates.
Data Sources:
MEDLINE and Embase databases were searched.
Study Eligibility Criteria:
We included original studies which investigated ARGs in stool or rectal swabs in neonates using molecular diagnostics.
Methods Of Data Synthesis:
Two authors independently extracted data, which were summarized in tables.
Results:
Our search identified 2701 studies, of which 23 (22 cohorts) were included. The studies show that the neonatal intestine harbours a high abundance and variety of ARGs, even in the absence of direct antibiotic exposure. The most commonly found ARGs confer resistance to aminoglycosides, β-lactams, macrolides, tetracyclines, or multidrug resistance. There is evidence that ARGs can be transferred from mothers to neonates. Interestingly, however, compared to mothers, neonates are reported to have a higher abundance of ARGs. One likely reason for this is the bacterial phylogenetic composition with a high abundance of Gammaproteobacteria in neonatal stool. Factors that have been associated with a higher abundance of ARGs are intrapartum and neonatal antibiotic use. Breastfeeding and neonatal probiotic use have been associated with a lower abundance of ARGs. Antibiotics during pregnancy, delivery mode, or sex are reported to have little effect. However, this might be because studies were underpowered and because it is difficult to account for effect modifiers.
Conclusions:
The neonatal intestine seems to have a lower colonization resistance, which could make it easier for antibiotic-resistant populations to establish themselves. Future studies will help in the development of evidence-based interventions to modulate the abundance of ARGs in neonates, for example, by the use of pre- and probiotics and bacteriophages.
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