Anti-anaerobic antibiotics associated with increased risk of mortality in critically ill patients (“Time-to-antibiotics” far too early)

Medical Xpress / University of Michigan / European Respiratory Journal ^ | Oct. 13, 2022 | Rishi Chanderraj et al

[ConservativeMind]

A common clinical practice may be inadvertently harming patients, according to research. The team behind the study suggest that administration of antibiotics with activity against anaerobic bacteria has a profound effect on the gut microbiome and, ultimately, an adverse impact on critically ill patients.

Researchers found that, in critically ill patients, the practice of early administration of anti-anaerobic antibiotics is commonplace—about two-thirds of the 3,032 patients observed in the study's cohort received such treatment.

"For sick patients in the Emergency Department and Intensive Care Unit, there has been a lot of focus on 'time-to-antibiotics' as a quality improvement measure," said Dickson. "Patients who received anti-anaerobic antibiotics did far worse than patients who didn't. We think that which antibiotic is given probably matters more than how quickly they are administered."

The researchers conducted a retrospective single-center cohort study of 3,032 critically ill patients, comparing those who did and did not receive early anti-anaerobic antibiotics. By comparing ICU outcomes in all patients, and changes in gut microbiota in 116 of the patients, they found that those who received anti-anaerobic antibiotics early in their hospital course had worse outcomes, whether measured in overall survival, infection-free survival, or pneumonia-free survival.

The authors also found dramatic consequences of these antibiotics on the gut microbiome—during hospitalization, patients who received anti-anaerobic antibiotics had decreased initial gut bacterial density, followed by increased expansion and domination of the microbiome Enterobacteriaceae (a genus of common bacteria, many of which are pathogenic and cause opportunistic infections in immunocompromised hosts). These findings confirm that anti-anaerobic antibiotics have a dramatic effect on gut bacterial communities.

While the primary findings were from an observational study in humans, the team confirmed the results using animal modeling. In two different mouse models (pneumonia and oxygen-induced lung injury), animals who were treated with anti-anaerobic antibiotics did worse.

[ConservativeMind]

One would not think antibiotics could be much of a bad thing, but for fragile people forced into the hospital for many days, antibiotics can be deadly, if done wrong.

[ConservativeMind]

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