Down-Syndrome-Related Maternal Dysbiosis Might Be Triggered by Certain Classes of Antibiotics: A New Insight into the Possible Pathomechanisms

Down syndrome (DS) is a leading human genomic abnormality resulting from the trisomy of chromosome 21. The genomic base of the aneuploidy behind this disease is complex, and this complexity poses formidable challenges to understanding the underlying molecular basis. In the spectrum of the classic DS risk factor associations, the role of nutrients, vitamins, and, in general, the foodborne-associated background, as part of the events ultimately leading to chromosome nondisjunction, has long been recognized as a well-established clinical association. The integrity of the microbiome is a basic condition in these events, and the dysbiosis may be associated with secondary health outcomes. The possible association of DS development with maternal gut microbiota should therefore require more attention. We have hypothesized that different classes of antibiotics might promote or inhibit the proliferation of different microbial taxa; and hence, we might find associations between the use of the different classes of antibiotics and the prevalence of DS through the modification of the microbiome. As antibiotics are considered major disruptors of the microbiome, it could be hypothesized that the consumption/exposure of certain classes of antibiotics might be associated with the prevalence of DS in European countries (N = 30). By utilizing three different statistical methods, comparisons have been made between the average yearly antibiotic consumption (1997-2020) and the estimated prevalence of people living with DS for the year 2019 as a percentage of the population in European countries. We have found strong statistical correlations between the consumption of tetracycline (J01A) and the narrow-spectrum, beta-lactamase-resistant penicillin (J01CF) and the prevalence of DS.

“Growth-Promoting Effect” of Antibiotic Use Could Explain the Global Obesity Pandemic: A European Survey

Clinical observations indicated a higher rate of obesity among children who received antibiotics at early ages. Experimental studies supported the role of the modified gut microbiome in the development of obesity as well. For identifying antibiotic classes that might promote or inhibit obesity-related dysbiosis, a database of the average yearly antibiotic consumption (2008–2018) has been developed using the European Center for Disease Prevention and Control (ECDC) yearly reports of antibiotic consumption in the community for the major antibiotic classes in 30 European countries, which were compared to the childhood and adult obesity prevalence featured in the Obesity Atlas. Pearson’s chi-square test was applied to estimate positive/negative correlations between antibiotic consumption and obesity. One-way ANOVA has been applied to test the differences in antibiotic consumption between groups, and logistic regression analysis was performed to determine the odds ratios (OR) of antibiotic consumption for obesity. Strong, positive associations were estimated between childhood obesity and the total consumption of systemic antibiotics, broad-spectrum, beta-lactamase-resistant penicillin, cephalosporin, and quinolone, and a negative correlation was found with the consumption of tetracycline, broad-spectrum, beta-lactamase-sensitive penicillin, and narrow-spectrum, beta-lactamase-sensitive penicillin. Our observation indicated that the “growth-promoting effect” of the consumption of certain antibiotic classes might be identified as a possible etiology in the development of obesity and might be the explanation for the obesity “pandemic”.

Alzheimer's Disease-Related Dysbiosis Might Be Triggered by Certain Classes of Antibiotics with Time-Lapse: New Insights into the Pathogenesis?

BACKGROUND

Several putative factors are identified in the literature as causative agents or risk factors for the development of Alzheimer's disease (AD). The amyloid cascade hypothesis has been the main hypothesis about the pathophysiology of AD for decades, but recent studies raised the possible role of dysbiosis in the development of AD, which prevents memory loss.

OBJECTIVE

Finding possible associations between antibiotic consumption patterns and the prevalence of AD in European countries.

METHODS

Antibiotic consumption (European Centre for Disease Prevention and Control, ECDC) for 1997-2007, 2008-2018, and as the whole 1997-2018 period, has been compared to the AD prevalence for 2018 expressed in percentage of the population and statistically analyzed by Pearson calculation.

RESULTS

A significant positive correlation has been found between the AD prevalence (2018) and the average quinolone consumption for the years 1997-2007 (r: 0.37, p: 0.044). A similar association was not observed for the entire 22 years (1997-2018) of the average quinolone consumption, and the years 2008-2018, indicating 10-20 years of time-lapse between the antibiotic exposure and the development of AD. The ratio of broad-spectrum and narrow-spectrum antibiotics (B/N) estimated in the ECDC database for the years of 2008-2018 showed a strong positive association with AD prevalence (2018) (r: 0.406, p: 0.026) and a positive correlation tendency for the entire 22 years 1997-2018 (r: 0.344, p: 0.063), but none for the years 1997-2007 (r: 0.256, p: 0.241).

CONCLUSION

Our study indicated the possible sequential role of certain classes of antibiotics in the development of dysbiosis leading to amyloid deposits of AD, which strengthen the possible role of different mediator molecules (short-chain fatty acids, lipopolysaccharides, etc.) produced by the altered microbiome in the development of AD.

Antibiotic Consumption Patterns in European Countries Might Be Associated with the Prevalence of Type 1 and 2 Diabetes

Several publications have raised the issue that the development of diabetes precedes the alteration of the microbiome (dysbiosis) and the role of environmental factors. Antibiotic use induces dysbiosis, and we wanted to estimate the associations between the consumption of antibiotics and the prevalence of diabetes (both types 1 and 2; T1D and T2D, respectively) in European countries. If such an association exists, the dominant use antibiotic classes might be reflected in the prevalence rates of T1D and T2D in different countries. Comparisons were performed between the prevalence of diabetes estimated for 2019 and featured in the Diabetes Atlas and the average yearly consumption of antibiotic classes between 2010 and 2109, calculated from the European Centre for Disease Prevention and Control (ECDC) yearly reports on antibiotic consumption in Europe. Pearson's correlation and variance analyses were used to estimate the possible relationship. Strong positive (enhancer) associations were found between the prevalence of T1D and the consumption of tetracycline (J01A: p = 0.001) and the narrow-spectrum penicillin (J01CE: p = 0.006; CF: p = 0.018). A strong negative (inhibitor) association was observed with broad-spectrum, beta-lactamase-resistant penicillin (J01CR: p = 0.003), macrolide (J01F: p = 0.008), and quinolone (J01M: p = 0.001). T2D showed significant positive associations with cephalosporin (J01D: p = 0.048) and quinolone (J01M: p = 0.025), and a non-significant negative association was detected with broad-spectrum, beta-lactamase-sensitive penicillin (J01CA: p = 0.067). Countries showing the highest prevalence rates of diabetes (top 10) showed concordance with the higher consumption of "enhancer" and the lower consumption of "inhibitor" antibiotics (top 10), as indicated by variance analysis. Countries with high prevalence rates of T1D showed high consumption of tetracycline (p = 0.015) and narrow-spectrum, beta-lactamase sensitive penicillin (p = 0.008) and low consumption of "inhibitor" antibiotics [broad-spectrum, beta-lactamase-resistant, combination penicillin (p = 0.005); cephalosporin (p = 0.036); and quinolone (p = 0.003)]. Countries with high prevalence rates of T2D consumed more cephalosporin (p = 0.084) and quinolone (p = 0.054) and less broad-spectrum, beta-lactamase-sensitive penicillin (p = 0.012) than did other countries. The development of diabetes-related dysbiosis might be related to the higher consumption of specific classes of antibiotics, showing positive (enhancer) associations with the prevalence of diabetes, and the low consumption of other classes of antibiotics, those showing negative (inhibitory) associations. These groups of antibiotics are different in T1D and T2D.

Dysbiosis in Parkinson's disease might be triggered by certain antibiotics

Parkinson's disease (PD) is a neurodegenerative amyloid disorder with debilitating motor symptoms due to the loss of dopamine-synthesizing, basal ganglia-projecting neurons in the substantia nigra. An interesting feature of the disease is that most of PD patients have gastrointestinal problems and bacterial dysbiosis, years before the full expression of motor symptoms. We hypothesized that antibiotic consumption might be a contributing factor of gut microbiome dysbiosis in PD, favoring curli-producing Enterobacteria. Curli is a bacterial α-synuclein (αSyn) which is deposited first in the enteric nervous system and amyloid deposits are propagated in a prion like manner to the central nervous system. In addition, antibiotics result in a low-grade systemic inflammation, which also contributes to damage of neurons in enteric- and central nervous system. To support our hypothesis, by comparing PD prevalence change with antibiotic consumption data in EU countries, we found significant positive correlation between use narrow spectrum penicillin + penicillinase resistant penicillin and increased prevalence of the disease.

Molecular epidemiology of VIM-4 metallo-beta-lactamase-producing Pseudomonas sp. isolates in Hungary

VIM metallo-beta-lactamase-producing serotype O11 or O12 Pseudomonas aeruginosa isolates infecting or colonizing 19 patients from seven hospitals in Hungary were characterized between October 2003 and November 2005. Macrorestriction analysis revealed the involvement of hospitals from three different towns in northwest Hungary in an outbreak caused by VIM-4-producing P. aeruginosa.

[Clinical aspects of the diagnosis and treatment of infectious mononucleosis in primary care and in departments of infectious diseases]

Medical documentation of the 342 patients hospitalised for infectious mononucleosis at the departments of infectious diseases of two county hospital was retrospectively reviewed between 1990 and 1996 and the most important clinical data were recorded. In order to document the effect of control measures, which were taken for the improvement diagnosis and therapy, data of the 105 infectious mononucleosis patients at one of the mentioned departments were also recorded in 1997 and 1998. The length of the time before the hospital admission (avg. 10.3 days), the length of the hospital stay (avg. 9.2 days) and the respectable amount of antibiotics taken for this indication show that this disease has great cost effect. High rate of classical clinical signs (fever, pharyngitis, lymphadenopathy, atypical cells) indicates, that the majority of the patients consulting their doctors presented the well-known signs of the disease. Only 43.6% of the patients were diagnosed as infectious mononucleosis by the G. P. s. Majority of the cases were treated for tonsillitis. 90.7% of the patients were given antibiotics before the hospital admission (avg. 1.6 antibiotics/person). 43.3% of the patients left the hospital without serologic diagnosis. After drowning lesson from the first part of this study, there was significant decrease in the rate of lack of serologic diagnosis and in the amount of consumption of antibiotics for this indication in the hospital, but there was no change at the level of G. P. s. The results of this paper demonstrate that the daily routine diagnosis and treatment of a well-known diseases differs remarkably from optimal practice. The fact is, that even if the physician has knowledge of a certain disease, does not necessarily mean that he uses it in his routine work. In order to reduce this failure, authors propose introduction of protocols and regular review of the practice.

The serological signs of the Epstein-Barr virus (EBV) activity in the elderly

The authors determined the IgM and IgG anti-Epstein-Barr virus (EBV)-VCA and anti-EBNA levels in single serum samples of 1882 patients with diagnose except infectious mononucleosis. The serological results were divided into four groups according to different serological patterns: the seronegative group, the IgM anti-VCA positive group (supposedly having actual EBV infection), the IgG (only) anti-VCA group (probably recent EBV infection or not sufficiently functioning cellular immunity) and IgG anti-VCA antibodies together with anti-EBNA (past EBV infection). The presence of heterophil antibodies was detected too. The incidence rates of the serological patterns were classified according to different age groups. It has been observed that the EBV seropositivity rapidly increases with age and over 60 years of age it is over 96%. At the same time the incidence rate of the IgM anti-VCA has gradually increased with age and from 3.66% in the age group of 0-10 years reached 11.98% in patients over 60 years of age. Significantly higher titres of IgG anti-VCA were found in the elderly group of patients as well. The distribution of heterophil antibody positive samples failed to show any significant distribution.

[Utilization of antibiotics according to most frequent indications at Hungarian hospitals and results of surveys]

Antibiotic utilisation of 8 Hungarian hospitals was analyzed examining the case histories of patients who were discharged between January 1 and 31, 1995. Usage of antibiotics in the most frequent indications is reported in this paper. Majority of the prescriptions for the treatment of upper and lower respiratory tract infections were broad spectrum beta lactams. Higher rate of penicillin usage was found only in tonsillitis cases. Besides II. generation cephalosporins (22.7% of 730 prescriptions), beta-lactamase inhibitor + aminopenicillin combinations (13.4%) and III. generation cephalosporins (9.5%) considerable quantity of aminoglycosides (14.9%) and quinolones (9.5%) were found in pneumonia. Relatively high rate of aminoglycosides in the treatment of lower respiratory infections is inconsistent with therapeutic guidelines in force. Co-trimoxazol and quinolones were most frequently prescribed for the treatment of lower urinary tract infections. Traditional urodesinficients were on the first place only at one hospital. Treatment of frequently occurring nosocomial infections was compared with those of community acquired at the same site. There was not significant difference in the utilisation rates of the most of antibiotic groups regarding place of disease acquisition. 44% of the 1373 prescriptions for perioperative profilaxis was indicated for clean operations where benefit of antibiotic administration is questionable. Duration of antibiotic profilaxis was more than 48 hours in 59% of prescriptions. Drugs most frequently used for perioperative profilaxis were II. generation cephalosporins (23.7%), metronidazol (16.7%), aminoglycosides (9.6%) and III. generation cephalosporines (9.6%). The authors compare their results to the literature. They suggest the setting up of "infection control committees" to organise the antibiotic policies in hospitals.

[Simple parameters of antibiotic utilization and diagnostic background of antimicrobial therapy in Hungarian hospitals in 1995]

This paper is published as second part of a survey on antibiotic utilisation of 8 Hungarian hospitals in January, 1995. The length of hospital stay of the patients receiving systemic antibiotic treatment was significantly higher (P < 0.0001) than those of not receiving such treatment. After exclusion of the patients suffering from nosocomial infections, average of the excess of hospital days was 4.65. Comparing the figures of patients receiving one or more antibiotic/one hospital stay and the rate of monotherapy and combined therapy and number of used antibiotics/100 discharged patients or/100 patients treated with antibiotics it was found that these indexes were most favourable in that hospital, where antibiotic policy was in function. Examining diagnoses (perioperative profilaxis 32.7%, pneumonia 13.3% of the 753 diagnoses) and drugs (metronidazol 26.3%, aminoglycosides 20% of the 1455 antibiotics) most frequently found in cases of combined antibiotic therapy it was concluded that parallel treatment with two or more antibiotic was often unjustified. Only 11% of antibiotics was used as directed against known bacteria. It was found that the rate of the achieved microbiological examinations and targeted therapy was low even if microbiological samples were easy to obtain. It was not the main purpose of the survey to get data of the clinical diagnostic background of antibiotic therapy, but indirect signs showed that these drugs were often used without sufficient clinical evidences (anamnesis, physical status, labor, X-ray and other tests) of infection. Authors recommend further survey in order to find out the causes of insufficiency of diagnoses. They also propose elaboration of diagnostic protocols.

[Usage of antibiotics in hospitals]

The authors publish the results of a survey conducted among hospital records of patients discharged from eight inpatient's institutes between 1-31st of January 1995 to gather information on the indications and usage of antibiotics. The institutes were selected from different part of the country to represent the hospital structure as much as possible. Data from the 13,719 documents were recorded and analysed by computer program. It was found that 27.6% of the patients (3749 cases) received antibiotic treatment. 407 different diagnosis and 365 different surgical procedures (as profilaxis) were considered as indications of antibiotic treatment (total: 4450 indications for 5849 antibiotic treatment). The largest group of patients receiving antibiotics was of antibiotic profilaxis (24.56%, 1093 cases), followed by lower respiratory tract infections (19.89%, 849 cases), uroinfections (10.53%, 469 cases) and upper respiratory tract infections. Relatively large group of patients belonged to those who had fever or subfebrility without known reason (7.35%, 327 cases) and to those who did not have any proof in their document indicating the reasons of antibiotic treatment (6.4%, 285 cases). We can not consider the antibiotic indications well founded in those groups of patients (every sixth or every fifth cases). The most frequently used antibiotics were of [2-nd] generation cefalosporins. The rate of nosocomial infections were found as 6.78% average. The results are demonstrated on diagrams and table.

[Serologic signs of Epstein-Barr-virus infections in various patients without infectious mononucleosis]

The authors detected Epstein-Barr virus (EBV) virus capsid (VCA) antibodies of IgM and IgG type together with EBNA and heterophil antibodies in the sera collected from 1882 unselected patients without infectious mononucleosis. Out of them IgM type antibodies were found in 123 cases and in an additional group of 30 patients heterophil antibodies were detected together with EBV specific virus markers. Altogether 153 patients were considered as cases of primary EBV infection, or reinfection. Comparing the distribution of age groups of the 1729 and the 153 patients, the author observed the increased incidence of elderly cases among patients with actual EBV infection, particularly above 60 years of age (P < 0.001). The 1729 patients were composed of 141 main diagnostic groups and the 153 patients with actual EBV infection consisted of 30 main diagnostic groups of which more than one third (53 cases) were of alcoholic liver diseases and patients of HBsAg carriers. The authors suppose, that in the cases of alcoholic liver diseases and of HBsAg carriers the suspected "immunocompromised" condition of those patients resulted the actual EBV infection, or reinfection. In other cases, like virus infection or meningitis serosa, it is suspected that the EBV can be responsible producing the symptoms.

[Serologic signs of Epstein Barr virus activity in acute viral hepatitis, symptomless HbsAg carriers as well as in alcoholic liver diseases]

The authors, based on their previous observations, analysed the serological incidence of the EBV infection in patients with viral hepatitis, HBsAg carriers and alcoholic liver diseases compared to control group. For the better statistical comparison they have selected the patients of 20-60 years of age and by using Khi-square probe, compared the incidence of IgM and IgG type antibodies against EBV in the samples. Significantly higher incidence (P < 0.05) of IgM antibodies were found in the samples of patients with alcoholic liver disease and of HBsAg carriers compared to the patients of viral hepatitis and control group. No similar distribution was observed related to the IgG type antibodies. Certain degree of "immunocompromised" condition is suspected in the cases of patients with HBsAg carrier state and with alcoholic liver disease known from the literature as the main reason behind the relatively more frequent Epstein-Barr virus infection.

[Sero-epidemiologic study of Epstein-Barr virus markers in patients without mononucleosis at a department for infectious diseases]

The authors have screened sera samples of 1817 unselected patients of not having infectious mononucleosis, admitted to their department, for Epstein-Barr virus (EBV) viruscapsid (VCA) IgM and IgG type antibody to detect the actual situation of EBV infection. The results were evaluated in age groups and in serological patterns. Their results indicated, that 80% of children became seropositive by 5-10 years of age and after 20 years, the rate of seropositivity was over 90% comparable to the reports from "developing" countries. IgM VCA antibodies were found in 103 samples (5.66%). The relatively high rate of only IgG VCA antibody-containing samples (480 cases, 26.41%) might indicate a previous EBV infection or the weakness of the cellular immunity of the given subject. Further studies are necessary to elucidate the problem.

[Indications for antimicrobial treatment in immunocompromised granulocytopenic patients]

The authors, based on the reviewed literature, call the attention to the main guidelines of the antimicrobial treatment of patients with impaired immunity with particular consideration to the patient with granulocytopenia. Individual evaluation is necessary in each of the cases according to tha nature and severity of the immunocompromised status, the localization of the infection and the type of the microorganism. The antimicrobial protocol in granulocytopenic, immunocompromised patients is extremely important in the cases of patients with fever of unknown origin. The main trends of the bacterial infections with emphasis on the reappearance of the gram positive cocci are evaluated. They describe the main types of the antimicrobial prophylaxis and the particular features of the organ-manifestations of the infections in the immunocompromised patients.

[Comparative study of antibiotic use at hospital departments in 7 Hungarian hospitals 1989-1991]

In their present work, authors, referring to their previous paper, wanted to compare the antibiotic consumption of the special medical fields in different hospitals. Computer database were utilised from different hospitals to obtain the necessary figures concerning antibiotic consumption. The amount of antibiotic consumption was expressed in Defined Daily Dose/1000 hospital day. The great differences found between hospitals in quality of antibiotic consumption related to the same subspeciality can be due to the different therapeutical approach in the respective departments. Quality of drug utilisation did not meet the expectations of the modern antibiotic therapy. Relatively low consumption was found in departments of ophthalmology, neurology, psychiatry and rehabilitation. Medium amount of antibiotic consumption was recorded in departments of internal medicine, general surgery, traumatology, obstetrics and gynecology, E. N. T. and dermatology. High antibiotic consumption was observed at the departments of urology, intensive care, infectology, pediatrics and pulmonology. Authors emphasise the importance of the education of the usage of antibiotics both at the medical universities and in postgraduate training as well.

[Comparative study of antibiotic consumption in Hungarian hospitals during 1989-1991]

The data of case histories of the year of 1989 of seven Hungarian hospitals and also the 1990 and 1991 data of two hospitals were collected and integrated in a database. Consumption of antibiotics were represented in DDD (Defined Daily Dose)/1000 hospital day. These data were compared with the data of the drugs delivered by the hospital pharmacy in one of the mentioned hospitals between 1989 and 1992. It was concluded that data based on case histories represent better the real antibiotic consumption than those of the hospital pharmacy. Reason of this phenomenon is the fact, that considerable amount of drug supply gets out of institutions. Great differences were observed between the seven hospitals in the total amount of antibiotic consumption and between the different antibiotic groups as well. Drugs most frequently used were tetracyclines, broad spectrum penicillins, sulfonamides and aminoglycosides. Consumption of penicillins was decreasing. Regarding new drugs only utilisation of quinolones was increasing. It was concluded, that structure of antibiotic selection did not follow the recommendations of the medical literature. The authors suggest that "antibiotic policy" should be introduced in Hungarian hospitals so as to imporve antibiotic utilisation.

[Differential diagnosis in patients with fever at the department for infectious diseases of a county hospital]

Between the 1st of January 1985 and the 31st of december 1989 101 patients were admitted for fever. Their data were analysed retrospectively. The patients were divided into three groups according to the diagnostic procedures. 32 patients belonged to the first group. The causes of their fever were diagnosed within 24 hours by simple clinical and laboratory means. The second group held 42 patients whose diagnosis were made within one week after detailed laboratory and clinical examinations. The third group (21 patients) fulfilled the criteria of FUO (Fever of Unknown Origin), and the authors analyse this group of patients. Most of the FUO group, 11 patients were diagnosed as infectious origin, 1 tumor, 4 autoimmune. In three cases the diagnosis remained unknown. Authors conclude that patients coming to hospital with fever should deserve more attention of specialist infectologists.