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J Infect Dis. 2019 Jun 13. pii: jiz299. doi: 10.1093/infdis/jiz299. [Epub ahead of print]

Identification of widespread antibiotic exposure in cholera patients correlates with clinically relevant microbiota changes.

Author information

1
Vincent Coates Foundation Mass Spectrometry Laboratory, Stanford University (USA).
2
Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh.
3
Institute for Global Health (IGH), University College London, London, United Kingdom.
4
Departments of Pediatrics and Environmental and Global Health, University of Florida (USA).
5
Department of Civil and Environmental Engineering, Stanford University (USA).
6
Department of Pediatrics, School of Medicine, Stanford University (USA).
7
Department of Microbiology, School of Medicine, Stanford University (USA).
8
Infection Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh.
9
Department of Medicine, School of Medicine, Stanford University (USA).

Abstract

BACKGROUND:

A first step to combating antimicrobial resistance in enteric pathogens is to establish an objective assessment of antibiotic exposure. Our goal was to develop and evaluate a liquid chromatography-ion trap mass spectrometry (LC/MS) method to determine antibiotic exposure in cholera patients.

METHODS:

A priority list for targeted LC/MS was generated from medication vendor surveys in Bangladesh. A study of cholera and non-cholera patients was conducted to collect and analyze paired urine and stool samples.

RESULTS:

Among 845 patients, 11% (n=90) were Vibrio cholerae positive; at least one antibiotic was detected in 86% and at least two in 52% of cholera stools. Among paired urine and stool (n=44), at least one antibiotic was detected in 98% and at least two in 84%, despite 55% self-reporting medication use. Compared to LC/MS, a low-cost antimicrobial detection bio-assay lacked sufficient negative predictive value (10%; 95% CI 6-16). Detection of guideline-recommended antibiotics in stool did (azithromycin; p=0.040) and did not (ciprofloxacin) correlate with V. cholerae suppression. A non-recommended antibiotic (metronidazole) was associated with decreases in anaerobes (Prevotella; p<0.001).

CONCLUSION:

The findings suggest there may be no true negative control group when attempting to account for antibiotic exposure in settings like those in this study.

KEYWORDS:

Vibrio cholerae ; AMR; Antimicrobial Resistance; Bangladesh; Cholera; Diarrhea; Diarrhoea; LC/MS; Mass Spectrometry

PMID:
31192364
DOI:
10.1093/infdis/jiz299

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