title: Vancomycin-resistant Enterococcus domination of intestinal microbiota is enabled by antibiotic treatment in mice and precedes bloodstream invasion in humans.
abstract: Bloodstream infection by highly antibiotic-resistant bacteria, such as vancomycin-resistant Enterococcus (VRE), is a growing clinical problem that increasingly defies medical intervention. Identifying patients at high risk for bacterial sepsis remains an important clinical challenge. Recent studies have shown that antibiotics can alter microbial diversity in the intestine. Here, we characterized these effects using 16s rDNA pyrosequencing and demonstrated that antibiotic treatment of mice enabled exogenously administered VRE to efficiently and nearly completely displace the normal microbiota of the small and large intestine. In the clinical setting, we found that intestinal domination by VRE preceded bloodstream infection in patients undergoing allogeneic hematopoietic stem cell transplantation. Our results demonstrate that antibiotics perturb the normal commensal microbiota and set the stage for intestinal domination by bacteria associated with hospital-acquired infections. Thus, high-throughput DNA sequencing of the intestinal microbiota could identify patients at high risk of developing bacterial sepsis.
authors.affiliation: Infectious Diseases Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. ubedamoc@mskcc.org
authors.forename: Carles
authors.initials: C
authors.lastname: Ubeda
authors.forename: Ying
authors.initials: Y
authors.lastname: Taur
authors.forename: Robert R
authors.initials: RR
authors.lastname: Jenq
authors.forename: Michele J
authors.initials: MJ
authors.lastname: Equinda
authors.forename: Tammy
authors.initials: T
authors.lastname: Son
authors.forename: Miriam
authors.initials: M
authors.lastname: Samstein
authors.forename: Agnes
authors.initials: A
authors.lastname: Viale
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Socci
authors.forename: Marcel R M
authors.initials: MR
authors.lastname: van den Brink
authors.forename: Mini
authors.initials: M
authors.lastname: Kamboj
authors.forename: Eric G
authors.initials: EG
authors.lastname: Pamer
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D016470:Bacteremia / Q000209:etiology / Q000382:microbiology; D001483:Base Sequence; D003428:Cross Infection / Q000209:etiology / Q000382:microbiology; D004269:DNA, Bacterial / Q000235:genetics; D004275:DNA, Ribosomal / Q000235:genetics; D016983:Enterococcus / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000209:etiology / Q000382:microbiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007422:Intestines / Q000187:drug effects / Q000382:microbiology*; D054892:Metagenome / Q000187:drug effects; D051379:Mice; D008810:Mice, Inbred C57BL; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D004275:DNA, Ribosomal