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Pathogenic colonization, antibiotic resistance occurs early in infancy
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Infant colonization with potentially pathogenic organisms and related antibiotic resistance occurred early during the first year of life, according to recent study findings.
In addition, early neonatal antibiotic exposures were found to be common, especially when considering perinatal maternal exposures as well as direct antibiotic treatment following delivery.
“Young infants in the U.S. receive, on average, more than one antibiotic course per year, and children can be major community reservoirs of resistant organisms, especially transmittable under relatively crowded conditions, such as within families and childcare,” Sharon B. Meropol, MD, PhD, a pediatrician in the division of general pediatrics and adolescent medicine at University Hospitals Rainbow Babies & Children’s Hospital and assistant professor at Case Western Reserve University School of Medicine, and colleagues wrote.
“Much U.S. data on the temporal course of infant colonization come from before the pneumococcal conjugate vaccine-era, and before the rising prevalence of methicillin-resistant Staphylococcus aureus and extended spectrum beta lactamase-producing gram-negative organisms.”
To assess the longitudinal colonization with bacterial pathogens and associated resistance to antibiotics among well-baby nursery admitted infants, Meropol and colleagues enrolled 35 (18 boys) Northeastern Ohio-dwelling infants aged 3 months and younger in a prospective, observational study of the respiratory and gastrointestinal tracts. In addition, the researchers sought to describe antibiotic responses concomitant with daycare exposures. The researchers conducted interviews with infants’ mothers to cull data on pregnancy-related medical history, demographic data and whether infants were exposed to antibiotics postpartum. They collected lab cultures for S. pneumoniae, S. aureus, and gram-negative enteric bacteria at baseline from infants and followed up at 3, 6, 9 and 12 months. Researchers also evaluated differences in infants’ household environment, including antibiotic use, household smoking, breast vs. formula feeding, daycare attendance and hospital admissions in visits during follow-up intervals.
Analysis showed dynamic outcomes in correlation between bacteria and antibiotic resistance in infants’ first year of life. Colonization occurred with S. pneumoniae, S. aureus, Escherichia coli, MRSA and third-generation cephalosporin resistant gram-negative bacteria at 3-month follow-up. Ten infants were colonized with an antibiotic-resistant organism in the first year, and three infants acquired pathogens that were resistant at an intermediate level. At final follow-up, 22 infants had received antibiotics, 20 infants had household members using antibiotics, 12 infants attended a daycare and 7 had household members with exposure to daycare.
“This finding strongly suggests that maternal antibiotic should be considered when describing and studying newborn exposure,” the researchers wrote. “Many previous studies took a cross-sectional approach, and did not consider previous episodes of antibiotic use and other individual and household covariates. This study suggests that each individual antibiotic exposure cannot be considered in isolation; this is supported by other work at the molecular level.” – by Kate Sherrer
Disclosure: This study was funded by University Hospitals Rainbow Babies & Children’s Hospitals and Case Western Reserve University School of Medicine. Meropol received NIH grant K23AI097284-01A1 from the National Institute for Allergy and Infectious Diseases. All other researchers report no relevant financial disclosures.
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