Ryan C Johnson1,2, Joy D Van Nostrand3, Michele Tisdale2,4,5, Brett Swierczewski6, Mark P Simons7, Patrick Connor8, Jamie Fraser2,4, Angela R Melton-Celsa9, David R Tribble4, Mark S Riddle1,10. 1. Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. 2. The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA. 3. Department of Microbiology and Plant Biology, Institute for Environmental Genomics, University of Oklahoma, Norman, Oklahoma, USA. 4. Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. 5. Naval Medical Center, Portsmouth, Virginia, USA. 6. Walter Reed Army Institute of Research, Silver Spring, Maryland, USA. 7. Naval Medical Research Center, Silver Spring, Maryland, USA. 8. Department of Military Medicine, Royal Centre for Defense Medicine, Birmingham, UK. 9. Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. 10. Department of Internal Medicine, University of Nevada Reno, School of Medicine, Reno, Nevada, USA.
Abstract
BACKGROUND: Travelers' diarrhea (TD) is common among military personnel deployed to tropical and subtropical regions. It remains unclear how TD and subsequent antibiotic treatment impact the resident microflora within the gut, especially given increased prevalence of antibiotic resistance among enteric pathogens and acquisition of multidrug-resistant organisms. We examined functional properties of the fecal microflora in response to TD, along with subsequent antibiotic treatment. METHODS: Fecal samples from US and UK military service members deployed to Djibouti, Kenya, and Honduras who presented with acute watery diarrhea were collected. A sample was collected at acute presentation to the clinic (day 0, before antibiotics), as well as 7 and/or 21 days following a single dose of antibiotics (azithromycin [500 mg], levofloxacin [500 mg], or rifaximin [1650 mg], all with loperamide). Each stool sample underwent culture and TaqMan reverse transcription polymerase chain reaction analyses for pathogen and antibiotic resistance gene detection. Purified DNA from each sample was analyzed using the HumiChip3.1 functional gene array. RESULTS: In total, 108 day 1 samples, 50 day 7 samples, and 94 day 21 samples were available for analysis from 119 subjects. Geographic location and disease severity were associated with distinct functional compositions of fecal samples. There were no overt functional differences between pre- and postantibiotic treatment samples, nor was there increased acquisition of antibiotic resistance determinants for any of the antibiotic regimens. CONCLUSIONS: These results indicate that single-dose antibiotic regimens may not drastically alter the functional or antibiotic resistance composition of fecal microflora, which should inform clinical practice guidelines and antimicrobial stewardship. CLINICAL TRIALS REGISTRATION NUMBER: NCT01618591. Published by Oxford University Press on behalf of Infectious Diseases Society of America 2021.
BACKGROUND: Travelers' diarrhea (TD) is common among military personnel deployed to tropical and subtropical regions. It remains unclear how TD and subsequent antibiotic treatment impact the resident microflora within the gut, especially given increased prevalence of antibiotic resistance among enteric pathogens and acquisition of multidrug-resistant organisms. We examined functional properties of the fecal microflora in response to TD, along with subsequent antibiotic treatment. METHODS: Fecal samples from US and UK military service members deployed to Djibouti, Kenya, and Honduras who presented with acute watery diarrhea were collected. A sample was collected at acute presentation to the clinic (day 0, before antibiotics), as well as 7 and/or 21 days following a single dose of antibiotics (azithromycin [500 mg], levofloxacin [500 mg], or rifaximin [1650 mg], all with loperamide). Each stool sample underwent culture and TaqMan reverse transcription polymerase chain reaction analyses for pathogen and antibiotic resistance gene detection. Purified DNA from each sample was analyzed using the HumiChip3.1 functional gene array. RESULTS: In total, 108 day 1 samples, 50 day 7 samples, and 94 day 21 samples were available for analysis from 119 subjects. Geographic location and disease severity were associated with distinct functional compositions of fecal samples. There were no overt functional differences between pre- and postantibiotic treatment samples, nor was there increased acquisition of antibiotic resistance determinants for any of the antibiotic regimens. CONCLUSIONS: These results indicate that single-dose antibiotic regimens may not drastically alter the functional or antibiotic resistance composition of fecal microflora, which should inform clinical practice guidelines and antimicrobial stewardship. CLINICAL TRIALS REGISTRATION NUMBER: NCT01618591. Published by Oxford University Press on behalf of Infectious Diseases Society of America 2021.
Authors: Maris S Arcilla; Jarne M van Hattem; Manon R Haverkate; Martin C J Bootsma; Perry J J van Genderen; Abraham Goorhuis; Martin P Grobusch; Astrid M Oude Lashof; Nicky Molhoek; Constance Schultsz; Ellen E Stobberingh; Henri A Verbrugh; Menno D de Jong; Damian C Melles; John Penders Journal: Lancet Infect Dis Date: 2016-10-14 Impact factor: 25.071
Authors: Edward P K Parker; Ira Praharaj; Jacob John; Saravanakumar Puthupalayam Kaliappan; Beate Kampmann; Gagandeep Kang; Nicholas C Grassly Journal: Sci Rep Date: 2017-08-23 Impact factor: 4.379
Authors: Daniel McDonald; Embriette Hyde; Justine W Debelius; James T Morton; Antonio Gonzalez; Gail Ackermann; Alexander A Aksenov; Bahar Behsaz; Caitriona Brennan; Yingfeng Chen; Lindsay DeRight Goldasich; Pieter C Dorrestein; Robert R Dunn; Ashkaan K Fahimipour; James Gaffney; Jack A Gilbert; Grant Gogul; Jessica L Green; Philip Hugenholtz; Greg Humphrey; Curtis Huttenhower; Matthew A Jackson; Stefan Janssen; Dilip V Jeste; Lingjing Jiang; Scott T Kelley; Dan Knights; Tomasz Kosciolek; Joshua Ladau; Jeff Leach; Clarisse Marotz; Dmitry Meleshko; Alexey V Melnik; Jessica L Metcalf; Hosein Mohimani; Emmanuel Montassier; Jose Navas-Molina; Tanya T Nguyen; Shyamal Peddada; Pavel Pevzner; Katherine S Pollard; Gholamali Rahnavard; Adam Robbins-Pianka; Naseer Sangwan; Joshua Shorenstein; Larry Smarr; Se Jin Song; Timothy Spector; Austin D Swafford; Varykina G Thackray; Luke R Thompson; Anupriya Tripathi; Yoshiki Vázquez-Baeza; Alison Vrbanac; Paul Wischmeyer; Elaine Wolfe; Qiyun Zhu; Rob Knight Journal: mSystems Date: 2018-05-15 Impact factor: 6.496
Authors: Mark S Riddle; Patrick Connor; Jamie Fraser; Chad K Porter; Brett Swierczewski; Emma J Hutley; Brook Danboise; Mark P Simons; Christine Hulseberg; Tahaniyat Lalani; Ramiro L Gutierrez; David R Tribble Journal: Clin Infect Dis Date: 2017-11-29 Impact factor: 9.079