Effect of the course of treatment with broad-spectrum antibiotics on intestinal flora and short-chain fatty acids in feces of very low birth weight infants: a prospective study

Therapeutic effects of microecological agents combined with metformin in type 2 diabetes mellitus with irritable bowel syndrome

BACKGROUND

In recent years, the role of intestinal flora in the occurrence and progression of irritable bowel syndrome (IBS) has been gradually recognized, and, as recommended agents for the treatment of IBS, probiotics, which can promote intestinal motility and correct and maintain the balance of flora, have been proven effective in the treatment of gastrointestinal diseases.

AIM

To investigate the therapeutic effects of microecological agents combined with metformin in patients with type 2 diabetes mellitus (T2DM) with IBS and their modulatory effect on the intestinal flora and the Toll-like receptor 4 (TLR4)/myeloid differentiation factor 88 (MyD8)/nuclear factor-κB (NF-κB) signaling pathway.

METHODS

Two hundred patients with T2DM with IBS treated at our hospital from August 2018 to August 2022 were selected and randomly divided into either a control group or an observation group, with 100 cases in each group. The control group was treated with metformin alone, and the observation group was treated with microecological agents combined with metformin. Intestinal sensitivity, intestinal flora (Lactobacillus, Bifidobacterium, Escherichia coli, and Enterococcus faecalis), short-chain fatty acids (SCFAs), blood glucose levels [fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), and 2-hour postprandial glucose (2hPG)], and serum levels of TLR4/MyD88/NF-κB signaling pathway-related proteins were compared between the two groups before and after treatment. The incidence of adverse effects was recorded.

RESULTS

After 4 wk and 8 wk of treatment, the numbers of Lactobacillus and Bifidobacterium were higher, and the numbers of E. coli and Enterococcus faecalis, intestinal sensitivity, and serum MyD88, TLR4, and NF-κBp65 levels were lower in the observation group than in the control group (P < 0.05). After 8 wk of treatment, the levels of butyric acid and total SCFAs were higher, and the levels of FPG, HbA1c, and 2hPG were lower in the observation group than in the control group (P < 0.05). The incidence of adverse reactions did not differ significantly between the observation group (9.00%) and the control group (14.00%).

CONCLUSION

Microecological agents combined with metformin can effectively reduce intestinal sensitivity, alleviate gastrointestinal symptoms, and enhance glucose control in patients with T2DM with IBS, which may be related to their ability to correct flora dysbiosis, regulate intestinal flora metabolites, and modulate the TLR4/MyD88/NF-κB signaling pathway by increasing the abundance of probiotics.

Association of necrotizing enterocolitis with antimicrobial exposure in preterm infants <32 weeks gestational age:A multicenter prospective case-control study

Objective: To assess the risk of necrotizing enterocolitis (NEC) and explore the relationship between antibiotic overexposure and disease occurrence in a large prospective birth cohort.

Methods: Based on a prospective birth cohort, the study collected hospitalization data of very preterm infants (VPIs) having gestational age of less than 32 weeks from January 1, 2018, to June 30, 2021 via the China Northern Neonatal Network. Infants diagnosed with NEC ≥ stage II were included in the case group, and each case was matched for GA and birth weight for the control group. Furthermore, the risk factors for NEC were determined by statistical analyses.

Results: A total of 6425 VPIs were included in this study, and 167 (2.6%) of these subjects were diagnosed with NEC ≥ stage II. The study also included 984 extremely preterm infants (gestational age &lt;28 weeks), including 50 (5.1%) infants diagnosed with NEC ≥ stage II. In the matched case-control study, subjects had a total of antibiotic days-of-therapy for 9015 days, of which broad-spectrum antibiotics (BSAs) accounted for 77%. The antibiotic spectrum index per antibiotic day in the case group was significantly higher and was an independent risk factor for the occurrence of NEC (p = 0.001, OR = 1.13).

Conclusion: The cohort of VPIs was overexposed to antiboitics. Unreasonable combination of antibiotics and overexposure to BSAs may increase the risk of NEC in preterm infants.

[Influence of enteral feeding initiation time on intestinal flora and metabolites in very low birth weight infants: a prospective study]

OBJECTIVES

To study the influence of enteral feeding initiation time on intestinal flora and metabolites in very low birth weight (VLBW) infants.

METHODS

A total of 29 VLBW infants who were admitted to the Department of Neonatology, Children's Hospital of Chongqing Medical University, from June to December, 2020, were enrolled as subjects. According to the enteral feeding initiation time after birth, the infants were divided into two groups: <24 hours (n=15) and 24-72 hours (n=14). Fecal samples were collected at weeks 2 and 4 of hospitalization, and 16S rDNA high-throughput sequencing and gas chromatography-mass spectrometry were used to analyze the microflora and short-chain fatty acids (SCFAs) respectively in fecal samples.

RESULTS

The analysis of microflora showed that there was no significant difference between the two groups in Chao index (reflecting the abundance of microflora) and Shannon index (reflecting the diversity of microflora) at weeks 2 and 4 after birth (P>0.05). The analysis of flora composition showed that there was no significant difference in the main microflora at the phylum and genus levels between the two groups at weeks 2 and 4 after birth (P>0.05). The comparison of SCFAs between the two groups showed that the <24 hours group had a significantly higher level of propionic acid than the 24-72 hours group at week 4 (P<0.05), while there was no significant difference in the total amount of SCFAs and the content of the other SCFAs between the two groups (P>0.05).

CONCLUSIONS

Early enteral feeding has no influence on the diversity and abundance of intestinal flora in VLBW infants, but enteral feeding within 24 hours can increase the level of propionic acid, a metabolite of intestinal flora.