背景:肠道微生物组为抗生素抗性基因(ARGs)提供了储库。在以后的生活中,新生儿微生物组比已建立的微生物组更容易受到外部因素的干扰。
目的:在这篇综述中,我们系统地总结了新生儿肠道抵抗的研究。
方法:搜索MEDLINE和Embase数据库。
方法:我们纳入了使用分子诊断法研究新生儿粪便或直肠拭子中ARG的原始研究。
■两位作者独立提取数据,在表格中进行了总结。
结果:我们的搜索确定了2701项研究,其中包括23个(22个队列)。研究表明,新生儿肠道含有大量和多种ARGs,即使在没有直接接触抗生素的情况下。最常见的ARGs赋予对氨基糖苷类的抗性,β-内酰胺,大环内酯类,四环素,或多药耐药性。有证据表明,ARGs可以从母亲转移到新生儿。有趣的是,然而,与母亲相比,据报道,新生儿的ARGs丰度较高。造成这种情况的一个可能原因是细菌系统发育组成,新生儿粪便中的γ变形菌含量很高。与较高ARGs丰度相关的因素是产时和新生儿抗生素的使用。母乳喂养和新生儿益生菌的使用与较低的ARG丰度有关。怀孕期间的抗生素,交货方式,或性被报道影响不大。然而,这可能是因为研究能力不足,并且因为很难解释效果修饰。
结论:新生儿肠道似乎具有较低的定植抗性,这可以使抗生素耐药人群更容易建立自己。未来的研究将有助于开发基于证据的干预措施,以调节新生儿中ARGs的丰度,例如,通过使用前和益生菌和噬菌体。
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.
OBJECTIVE: In this
review, we systematically summarize studies which investigated the intestinal resistome in neonates.
METHODS: MEDLINE and Embase databases were searched.
METHODS: We included original studies which investigated ARGs in stool or rectal swabs in neonates using molecular diagnostics.
UNASSIGNED: 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.