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Updated: Jul 26, 2025
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Issues beyond resistance: inadequate antibiotic therapy and bacterial hypervirulence
Lee W Goneau1,2,3, Johannes Delport4, Luana Langlois1
1Department of Microbiology and Immunology, Western University, London, Ontario, Canada.
Abstract:
The administration of antibiotics while critical for treatment, can be accompanied by potentially severe complications. These include toxicities associated with the drugs themselves, the selection of resistant organisms and depletion of endogenous host microbiota. In addition, antibiotics may be associated with less well-recognized complications arising through changes in the pathogens themselves. Growing evidence suggests that organisms exposed to antibiotics can respond by altering the expression of toxins, invasins and adhesins, as well as biofilm, resistance and persistence factors. The clinical significance of these changes continues to be explored; however, it is possible that treatment with antibiotics may inadvertently precipitate a worsening of the clinical course of disease. Efforts are needed to adjust or augment antibiotic therapy to prevent the transition of pathogens to hypervirulent states. Better understanding the role of antibiotic-microbe interactions and how these can influence disease course is critical given the implications on prescription guidelines and antimicrobial stewardship policies.
Insights
Antibiotics can cause severe complications beyond toxicity, including making pathogens more dangerous. Understanding these antibiotic-microbe interactions is crucial for improving treatment and antimicrobial stewardship.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Antibiotic administration is essential for treating infections but carries risks.
- Complications include drug toxicities, antimicrobial resistance, and microbiota disruption.
- Emerging evidence highlights pathogen-mediated complications due to antibiotic exposure.
Purpose of the Study:
- To explore the less recognized complications of antibiotic therapy.
- To investigate how antibiotics can alter pathogen virulence factors.
- To emphasize the need for improved understanding of antibiotic-microbe interactions.
Main Methods:
- Review of current scientific literature on antibiotic-pathogen interactions.
- Analysis of evidence linking antibiotic exposure to changes in pathogen virulence.
- Exploration of the clinical significance of these pathogen alterations.
Main Results:
- Antibiotics can induce changes in pathogens, affecting toxins, invasins, adhesins, biofilm, and resistance.
- These antibiotic-induced pathogen modifications may lead to a worsening clinical course.
- The clinical impact of these virulence changes requires further investigation.
Conclusions:
- Antibiotic therapy may inadvertently enhance pathogen virulence, complicating disease management.
- Further research into antibiotic-microbe interactions is critical for refining treatment strategies.
- Adjusting antibiotic regimens and enhancing antimicrobial stewardship are necessary to prevent pathogen hypervirulence.
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