Conclusion: The affiliation of Saccharomyces boulardii with particular strains of Lactobacillus and Bifidobacterium influences antibiotic therapy by counteracting the colonization of the colon microbiota with antibiotic-resistant pathogens.
Outcomes
: Treatment with the probiotic combination led to a big decline in colonization with Pseudomonas after antibiotic therapy from 25 to eight.3% ( p = 0.041). Colonization with AmpC-producing enterobacteria was transiently elevated after the antibiotic therapy ( p = 0.027) and declined after the probiotic intervention (p= 0.041). No vital modifications have been noticed within the placebo and Saccharomyces teams. As much as 2 years after the trial, no an infection with ESBL-producing micro organism was noticed within the probiotic combination group.
Technique: In complete, 120 sufferers handled for 10 days with amoxicillin-clavulanate antibiotics have been included in a randomized, placebo-controlled, double-blinded trial, evaluating the consequences of a 30 days therapy with placebo Saccharomyces boulardii CNCM I-745 ® and a probiotic combination containing Saccharomyces boulardii, Lactobacillus acidophilus NCFM, Lactobacillus paracasei Lpc-37, Bifidobacterium lactis Bl-04, and Bifidobacterium lactis Bi-07 (Bactiol duo ® ). Examine therapy was initiated inside 48 h of the antibiotic being initiated. Many of the sufferers included have been aged with a imply age of 78 years previous with a number of comorbidities. Stools have been collected on the time of inclusion within the trial, on the finish of the antibiotic therapy, and the tip of the examine therapy. These have been cultured on selective antibiotic media.
Goal: Most infections with Enterobacteriaceae producing AmpC β-lactamase (AmpC)-, extended-spectrum β-lactamase (ESBL)-, and carbapenemase-producing micro organism, vancomycin-resistant Enterococcus in addition to naturally resistant non-fermenting micro organism resembling Pseudomonas aeruginosa , are associated to a previous colonization of the intestine microbiota. The target of this examine was to find out whether or not therapy with probiotics throughout an antibiotic therapy may stop the colonization of the intestine microbiota with multi-drug resistant micro organism.
References – Probiotics During Antibiotic Treatment
Infections with multi-drug resistant micro organism (MDR) resembling extended-spectrum β-lactamase (ESBL)-, AmpC β-lactamase (AmpC)-, and carbapenemase-producing Enterobacteria (CPE), vancomycin-resistant Enterococcus (VRE), or naturally resistant non-fermenting micro organism resembling Pseudomonas aeruginosa are related to a excessive mortality price (1–3). The danger of creating an an infection with MDR micro organism is relative to the abundance of fecal MDR (2, 4–6). Such colonization is often known as the resistome, which is related to an extended keep in a healthcare setting and a number of antibiotic therapies. In clinics, infection-control groups consider fecal colonization with MDR micro organism by analyzing the presence of micro organism rising in vitro on selective media.
The event of latest antibiotics for energetic an infection with MDR micro organism could be very sluggish, highlighting the necessity for various methods to stop the unfold of antibiotic-resistant micro organism. Amongst these methods, the effectiveness of decreasing colonization of the intestinal microbiota by MDR micro organism utilizing probiotics is being supported by in vitro and scientific observations (7, 8). The usage of probiotic strains resembling Lactiplantibacillus plantarum or Limosilactobacillus fermentum (previously named Lactobacillus plantarum or Lactobacillus fermentum) was related to a discount in colonization with naturally resistant pathogens, resembling Acinetobacter baumannii, Pseudomonas aeruginosa, and Candida albicans (9, 10). Sufferers colonized with ESBL-producing Enterobacteriaceae have been handled with a mix of eight viable bacterial strains (Vivomix®) at a dose of 9.1011 twice day by day for two month. They skilled a 2.5-fold lower in bacterial colonization 1 yr later (11). Moreover, the danger of colonization of the intestine microbiota with VRE in sufferers with hematological malignancies is low within the presence of the genus Barnesiella within the Bacteroidetes group, following therapy with L. paracasei (8, 12–14).
However, using probiotics isn’t a one-size-fits-all technique, and probiotic pressure specificities influence their potential to eradicate the resistome. This examine goals to find out the scientific circumstances wherein probiotic therapy may lower the burden of antibiotic resistance as outlined by scientific requirements.
Sufferers and Strategies
This examine was a double-blind, placebo-controlled, randomized trial. Contaminated sufferers handled with the antibiotic amoxicillin-clavulanate have been randomly assigned to one of many three parallel teams in 1:1:1 ratio to obtain therapy with a probiotic combination, Saccharomyces, or placebo (Determine 1). The exclusion standards have been as follows: age beneath 18 years; being pregnant; breastfeeding; the typical variety of well-formed bowel actions greater than three per day or fewer than three per week; participation in a scientific analysis trial 30 days previous to randomization; common use of pro- and/or prebiotics; unstable medical situation; a historical past of persistent gastrointestinal problems together with irritable bowel syndrome, colitis, and Crohn’s illness; allergy or sensitivity to check product substances or antibiotics; dialysis; deglutition abnormalities prohibiting or stopping regular oral consumption; and therapy with different antibiotics on the time of randomization.
FIGURE 1
Determine 1. Randomized managed trial movement chart. Ten sufferers have been misplaced earlier than assortment of the stool pattern at go to 2: 4 refused to offer the pattern, three weren’t compliant with the therapy, and three died. Thirty-two sufferers have been misplaced at go to 3: 19 refused to offer the pattern, 9 weren’t compliant with the therapy, and 4 died.
The sufferers have been chosen from the interior drugs and geriatrics wards at Clinique Saint Pierre in Ottignies, Belgium. They have been hospitalized due to infectious ailments and handled empirically with amoxicillin 4,000 mg/clavulanate at 800 mg divided into 4 doses and administrated by the intravenous route, and amoxicillin at 2,625 mg/clavulanate at 375 mg divided into three doses and administrated by the oral route for a complete of 10 days.
Intervention
The sufferers have been randomly assigned a probiotic combination, Saccharomyces boulardii, or placebo. The probiotic combination contained Saccharomyces boulardii at 6 × 109 CFU/capsule; Lactobacillus acidophilus NCFM at 2 × 109 CFU/capsule; Bifidobacterium animalis subsp. lactis Bi-07 at 2 × 109 CFU/capsule; Bifidobacterium animalis subsp. lactis Bl-04 at 2 × 109 CFU/capsule; Lacticaseibacillus paracasei Lpc-37 (previously Lactobacillus paracasei) at 2 × 109 CFU/capsule; blackberry fruit and leaf at 50 mg, cholecalciferol at 1.25 μg; and microcrystalline cellulose (40 mg), silicon dioxide (4 mg), and magnesium stearate excipients (4 mg) (Bactiol Duo®, Metagenics Europe). The Saccharomyces product contained Saccharomyces boulardii at 6 × 109 CFU/capsule; mannitol (60 mg), magnesium stearate (6.7 mg), and silicon dioxide (3 mg) excipients. The placebo examine product contained microcrystalline cellulose, dibasic anhydrous calcium phosphate, silicon dioxide, and magnesium stearate. The investigational product was labeled and coded in response to the native regulatory tips.
Sufferers have been instructed to take one capsule two occasions a day throughout a meal: as soon as at breakfast and as soon as at dinner. A nurse managed the administration of the examine product throughout hospitalization. The therapy continued at dwelling as much as 30 days of therapy with the examine product. To observe adherence at dwelling, sufferers have been instructed to return leftover capsules and/or empty packing containers on the finish of the examine. Sufferers have been additionally requested to finish a questionnaire on therapy compliance and tolerance.
The first endpoint was the presence of optimistic fecal cultures with ESBL- or AmpC-producing micro organism, CPE, VRE, or naturally resistant non-fermenting micro organism after antibiotic therapy and after the examine therapy.
A pattern measurement of 40 topics per group was required to detect clinically vital variations of 10% at 80% energy, with 15% distinction in statistical strategies, permitting for a 20% attrition price (15).
Randomization and Blinding
For participant allocation, a computer-generated record of random numbers was created utilizing a blocked randomization sequence with a random block measurement of two or three (R model 3.2.0 blockr and, R Core Staff, 2019). Each examine merchandise and placebo merchandise have been stuffed in opaque capsules of an identical look. They have been prepacked in packing containers and numbered in response to the randomization schedule. Every affected person was assigned an order quantity and acquired the capsule from the corresponding prepacked field. Treatment allocation trusted a random quantity record ready by an investigator with no scientific involvement within the trial. The scientific investigators have been liable for shelling out the examine product to the themes as per the randomization schedule after acquiring the sufferers’ consent. The sufferers and workers concerned in product shelling out, go to evaluation, the conduct of the examine, and monitoring and evaluation of information remained blinded at some point of the examine.
Stool Evaluation
A stool pattern was collected in a sterile container on the time of inclusion within the trial on: go to 1, on common 42.4 ± 28.1 h after the primary dose of antibiotics, on the finish of the antibiotic therapy; go to 2, on common 11.6 ± 5.0 days after the primary dose of antibiotics, and examine therapy, and 1 to three months after discharge from the hospital; and go to 3, on common 60.8 ± 53.9 days after the primary dose of antibiotics. All visits above are expressed as imply ± commonplace deviation. Samples have been inoculated inside 2 h of assortment with a 10-μL loop on three selective media, i.e., chromID ESBL (bioMérieux, France), chromID VRE (bioMérieux, France), and chromID CarbaSMART agar (bioMérieux, France), and incubated aerobically at 37°C for twenty-four h or as much as 48 h if no bacterial development was noticed at 24 h. Many of the selective media have been loaded with broad-spectrum third-generation cephalosporins (C3). Organisms rising in such circumstances are C3 resistant. Organisms have been recognized by matrix-assisted laser desorption ionization time-of-flight mass spectrometry ([MALDI-TOF MS]; Bruker Biotyper, Bruker Daltonics, Germany). Antimicrobial susceptibility testing was carried out on the VITEK 2 platform for Enterobacteriaceae (AST-N366 card) and Enterococcus spp. (AST-P586 card) and on Mueller-Hinton agar plates by disk diffusion for non-fermenting gram-negative micro organism. The breakpoints really useful by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) have been used to assign the next scientific susceptibility classes: inclined, intermediate, or resistant. Phenotypic affirmation of ESBL manufacturing was carried out utilizing the mix disk check really useful by the EUCAST. Phenotypic AmpC affirmation exams have been carried out with the inhibition of AmpC by cloxacillin with Cefotaxime+Cloxacillin Rosco tablets. Carbapenemase manufacturing was confirmed by the immunochromatographic lateral movement check RESIST-3 O.Okay.N. (Coris BioConcept, Belgium).
Statistical Evaluation
Categorical information have been summarized as frequency and proportion. For every therapy, modifications within the resistance of bacterial strains between visits have been in contrast by McNemar’s Chi–squared check. Variations within the proportion of colonization between the therapy teams have been analyzed by Chi–squared check for unbiased variables. A worth of p < 0.05 was thought of statistically vital. All analyses have been carried out in R model 3.2.0 (R Core Staff, 2019). Moral Approval The protocol of the examine was accepted by the Comité d'éthique Hospitalo-Facultaire Universitaire de Liège 707, quantity 2017-131, which has the authorized energy to totally agree with the content material of the protocol from June 07, 2017. Probiotics will not be thought of a medicinal product in response to European and native tips, and this examine has no therapeutic declare requiring registration in a database. All sufferers taking part within the trial signed an knowledgeable consent type. The examine was carried out in response to the ICH GCP tips and the Declaration of Helsinki. For people who have been cognitively impaired and/or unable to offer knowledgeable consent, consent was granted by the authorized consultant.
Outcomes
Examine Inhabitants
Between September 2017 and October 2019, 703 sufferers have been assessed for eligibility. Out of them, 120 have been randomized into one of many three examine teams. The follow-up was accomplished in November 2019 (Determine 1). 75% of the themes have been ≥71 years previous and had a number of comorbidities (Desk 1). The sufferers have been initially handled by the intravenous route, besides for 3 sufferers: one within the placebo arm and two within the probiotic combination arm. The antibiotic therapy was tailored with the adjunction of or change to a different antibiotic in 50 sufferers after analyzing their bacterial tradition and studying the antibiogram (Desk 2). There was no distinction within the proportion of consumption of different antibiotics among the many therapy teams (p = 0.429). No vital distinction in colonization with C3-resistant micro organism was noticed between teams on the time of inclusion (Desk 3).
TABLE 1
Desk 1. Affected person traits.
TABLE 2
Desk 2. Adjunction of or change to different antibiotic therapies.
TABLE 3
Desk 3. Publish-hoc evaluation of bacterial cultures.
Six months after the inclusion of the final affected person within the trial, we reviewed the bacterial cultures for all of the included sufferers utilizing samples remoted from infectious sources. This represents a comply with up interval of as much as 2 years and 10 optimistic cultures in every arm. Within the placebo arm, ESBL-producing micro organism have been retrieved in three urinary cultures, and Pseudomonas aeruginosa was retrieved in two urinary cultures and one sputum tradition. Within the Saccharomyces arm, ESBL-producing micro organism have been retrieved in a single blood tradition, and Pseudomonas aeruginosa, in two urine cultures and one blood tradition. Nonetheless, within the probiotic combination arm, ESBL-producing micro organism weren’t retrieved in any of the cultures. Pseudomonas aeruginosa was retrieved in two sputum cultures (Desk 3). This statement is solely informative because the trial was not designed to determine prevention of an infection with multi-drug resistant micro organism.
The survival price was comparable in all therapy teams (p = 0.460).
Final result of the Intervention
Colonization With C3-Resistant Non-fermenting Micro organism
Within the placebo arm, 28.9% (11/38) of sufferers have been colonized with non-fermenting micro organism at go to 2 in contrast with 23.7% (9/38) at go to 1 (n.s.). Within the Saccharomyces arm, 22.2% (8/36) of the sufferers have been colonized at go to 2 in comparison with 33.3% (12/36) at go to 1 (n.s.).
Within the probiotic combination arm, 8.3% (3/36) of the sufferers have been colonized at go to 2 as in comparison with 25% (9/36) at go to 1, displaying a big lower in colonization (p = 0.041). This phenomenon was related to particular decolonization of Pseudomonas (go to 1 vs. go to 2, p = 0.041). No new colonization with Pseudomonas was noticed from go to 1 to go to 2. This pattern was noticed all through the entire examine period as 18.5% (5/27) of the sufferers have been colonized at go to 3 (go to 2 vs. go to 3, p = 0.617) in comparison with 30% (8/26) within the placebo arm and 36% (9/25) within the Saccharomyces arm.
Colonization With C3-Resistant Enterobacteria
Within the placebo and Saccharomyces arms, the colonization price with C3-resistant enterobacteria between go to 1 and go to 2 elevated, respectively, from 15.8% (6/38) and 22.2% (8/36) to 29% (11/38) and 33.3% (12/36) (p = n.s.) (Desk 4). No vital change within the colonization price was noticed on the finish of the trial.
TABLE 4
Desk 4. C3-resistant micro organism.
Within the probiotic combination arm, the colonization price elevated from 25% (9/36) to 52.7% (19/36) (p = 0.016). This improve within the resistance is defined by a 22.9% improve in colonization with AmpC-producing enterobacteria (go to 2 vs. go to 1, p = 0.027) within the probiotic combination arm, as in comparison with a ten.2% improve within the placebo arm and a 5.4% improve within the Saccharomyces arm (n.s.). The proportion of sufferers colonized with AmpC-producing enterobacteria have been steady between go to 2 and go to 3 within the placebo and Saccharomyces arms (n.s.) whereas a big decline was seen within the probiotic combination arm to three.8% at go to 3 (p = 0.041) (Determine 2).
FIGURE 2
Determine 2. Colonization by therapy group. (A) Colonization with broad spectrum C3-resistant micro organism. In all teams of therapy, the proportion of sufferers colonized with C3 resistant enterobacteria improve at go to 2. Within the Probiotic combination group, this improve was extra necessary attributable to a inhabitants of enterobacteria displaying the phenotypic traits of expression of AmpC. The colonization with Pseudomonas decreased strongly within the Probiotic combination group at go to 2. Colonization with C3 resistant micro organism returned to the basal ranges at go to 3. (B) Adjustments within the price of colonization from go to 1 to 2 or go to 2 to three: (*) elevated the proportion of C3-resistant micro organism within the probiotic combination arm between go to 1 and go to 2, confirmed by a 25% improve in AmpC-producing enterobacteria (p = 0.027). (**) Paired evaluation of colonization with C3-resistant micro organism exhibits a 16% discount of colonization with non-fermenting micro organism within the probiotic combination arm between go to 1 and go to 2, defined by a discount in Pseudomonas species (p = 0.041). (&) Discount in colonization by 23.1% after the examine therapy was noticed at go to 3 within the probiotic combine arm, akin to the proportion of sufferers who have been colonized at go to 1 (p = 0.041).
Colonization With ESBL- or Carbapenemase-Producing Micro organism and VRE
The prevalence of colonization with ESBL-producing enterobacteria elevated on the finish of the antibiotic therapy within the placebo, Saccharomyces and probiotic combination arms from 10.3% (4/39), 7.7% (3/39), and 23.1% (9/39) to fifteen.4% (6/39), 16.7% (6/36), and 27.8% (10/36), respectively (n.s.). The colonization charges have been normalized to the preliminary values at go to 3 (11.1% [3/27], 8.0% [2/25], and 19.2% [5/26], respectively).
Just one affected person was colonized with CPE-producing micro organism within the probiotic combination arm after antibiotic remedy, however confirmed adverse outcomes after the examine therapy. One affected person within the placebo and one within the Saccharomyces arm have been already colonized with CPE-producing micro organism on the time of inclusion, and each confirmed adverse outcomes at go to 3 and go to 2, respectively (Desk 4). One affected person was colonized with VRE on the time of inclusion within the placebo arm that VRE was not retrieved at go to 3.
Dialogue
Many of the sufferers have been aged and had necessary comorbidities. Stool assortment was inconceivable at dwelling for these sufferers, explaining the shortage of follow-up between visits 2 and three. Blackcurrant leaf and fruit within the composition of the probiotic combination weren’t taken into consideration for the preparation of the placebo. As a prebiotic, its results on Pseudomonas are restricted to phenotypic modifications as biofilm formation. Contemplating the low focus within the preparation, its impact on the microbiome is negligible (16).
We noticed an overrepresentation of enterobacteria with the phenotypic attribute of AmpC expression within the stool pattern collected after the antibiotic therapy (go to 2) within the probiotic combination group. AmpC is understood to be upregulated in enterobacteria within the presence of amoxicillin-clavulanate and will due to this fact be due close to the tip of the antibiotic remedy, (17, 18) AmpC ought to be thought of as an enzyme implicated within the homeostasis of the bacterial cell wall. Its expression is determined by the focus in cell wall fragments within the cytosol. When the degradation of the cell wall accelerates, the expression of AmpC will increase in a parallel method for muropeptides or peptidoglycans. As Lactobacillus and Bifidobacterium are inclined to amoxicillin-clavulanate, their actions on enterobacteria may very well be mediated by muropeptides and peptidoglycans launched after the demise of the probiotic micro organism which may very well be linked to the probiotic combination group (19). Not one of the sufferers confirmed an infection with AmpC-producing micro organism.
On this examine, a discount in colonization with Pseudomonas was seen all through the period of probiotic combination therapy. Different research have additionally confirmed this pattern in wound and respiratory tract infections in sufferers handled with L. plantarum and L. rhamnosus, respectively (20, 21). Probiotic micro organism could immediately have an effect on the proliferation of MDR by producing antimicrobial compounds resembling short-chain fatty acids, hydrogen peroxide, nitric oxide, or bacteriocin or not directly have an effect on it by modifying the intestinal epithelial barrier, by adherence, or by competing for the substrate (22, 23). The predominance of Lactobacillus spp. within the intestine microbiota was additionally noticed in sufferers who didn’t purchase VRE after in-hospital antibiotic therapy (24).
Due to this fact, plainly probiotic therapy shouldn’t be supplied as a single technique of therapy, however ought to contain particular therapies relying on the probiotic micro organism, with tailored posology. Probiotic mixtures composed of lactobacilli and bifidobacteria ought to be given earlier than and after the antibiotic therapy to stop colonization with bacterial populations immune to the antibiotics.
Abstract of the Article’s Important Level
Treatment with a probiotic combination associating lactobacilli, bifidobacteria and Saccharomyces throughout an in-hospital antibiotic therapy is related to a lower in colonization of the intestine microbiota with Pseudomonas and with a transient colonization with AmpC producing enterobacteria after the antibiotic therapy which was not retrieved on the finish of the examine therapy.
Information Availability Assertion
The uncooked information supporting the conclusions of this text might be made obtainable by the authors, with out undue reservation.
Ethics Assertion
The protocol of the examine was accepted by the Comité d’éthique Hospitalo-Facultaire Universitaire de Liège 707, quantity 2017-131 that has authorized energy to totally agreed with the content material of the protocol on the seventh of June 2017. Probiotics will not be thought of as medicinal product in accordance with European and native tips and this examine has no therapeutic declare. As such, this analysis isn’t thought of a scientific trial, and registration in an official database isn’t required. All sufferers taking part within the trial signed an knowledgeable consent type. The examine was carried out in response to the ICH GCP tips and the Declaration of Helsinki. For people who have been cognitively impaired and/or unable to offer knowledgeable consent, consent was granted by the authorized consultant.
Writer Contributions
GW: conception and design of the examine, acquisition, evaluation, and interpretation of information, drafting the article, revising the article critically for mental content material, and guarantor of the information. VV: evaluation and interpretation of information. MVDD: conception and design of the examine, evaluation, and interpretation of information. EM: evaluation and interpretation of information. GV: evaluation and interpretation of information. J-CM: important revision of the article for mental content material. PDC: conception and design of the examine and demanding revision of the article for mental content material.
Funding
This trial was supported by Metagenics Europe.
Battle of Curiosity
GW experiences grants from Metagenics, through the conduct of the examine. MV and GV experiences non-financial help from Metagenics Europe, through the conduct of the examine and an worker of Metagenics Europe, distributor of Bactiol duo used on this trial. PC is inventor on patent purposes coping with using A.muciniphila and its parts within the therapy of weight problems and associated problems and co-founder of A-Mansia biotech SA.
The remaining authors declare that the analysis was carried out within the absence of any industrial or monetary relationships that may very well be construed as a possible battle of curiosity.
Acknowledgments
We wish to thank Margueritte Storm for her assist in manuscript preparation and English language enhancing.
Supplementary Materials
The
Supplementary Materials
for this text will be discovered on-line at: https://www.frontiersin.org/articles/10.3389/fpubh.2020.578089/full#supplementary-material
References
1. Thaden JT, Park LP, Maskarinec SA, Ruffin F, Fowler VG Jr, van Duin D.
Outcomes
from a 13-year potential cohort examine present elevated mortality related to bloodstream infections brought on by Pseudomonas aeruginosa in comparison with different micro organism. Antimicrob Brokers Chemother. (2017) 61:e02671–16. doi: 10.1128/AAC.02671-16 CrossRef Full Textual content | Google Scholar
2. Kang CI, Chung DR, Ko KS, Peck KR, Track JH, Korean Community for Examine of Infectious D. Danger components for an infection and therapy end result of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae bacteremia in sufferers with hematologic malignancy. Ann Hematol. (2012) 91:115–21. doi: 10.1007/s00277-011-1247-7 PubMed Summary | CrossRef Full Textual content | Google Scholar
3. Shamsrizi P, Gladstone BP, Carrara E, Luise D, Cona A, Bovo C, et al. Variation of impact estimates within the evaluation of mortality and size of hospital keep in sufferers with infections brought on by bacteria-producing extended-spectrum beta-lactamases: a scientific overview and meta-analysis. BMJ Open. (2020) 10:e030266. doi: 10.1136/bmjopen-2019-030266 PubMed Summary | CrossRef Full Textual content | Google Scholar
4. Golzarri MF, Silva-Sanchez J, Cornejo-Juarez P, Barrios-Camacho H, Chora-Hernández LD, Velázquez-Acosta C, et al. Colonization by fecal extended-spectrum beta-lactamase-producing Enterobacteriaceae and surgical web site infections in sufferers with most cancers present process gastrointestinal and gynecologic surgical procedure. Am J Infect Management. (2019) 47:916–21. doi: 10.1016/j.ajic.2019.01.020 PubMed Summary | CrossRef Full Textual content | Google Scholar
5. Ruppe E, Lixandru B, Cojocaru R, Büke C, Paramythiotou E, Angebault C, et al. Relative fecal abundance of extended-spectrum-beta-lactamase-producing Escherichia coli strains and their incidence in urinary tract infections in girls. Antimicrob Brokers Chemother. (2013) 57:4512–7. doi: 10.1128/AAC.00238-13 PubMed Summary | CrossRef Full Textual content | Google Scholar
6. Detsis M, Karanika S, Mylonakis E. ICU Acquisition price, danger components, and scientific significance of digestive tract colonization with extended-spectrum beta-lactamase-producing enterobacteriaceae: a scientific overview and meta-analysis. Crit Care Med. (2017) 45:705–14. doi: 10.1097/CCM.0000000000002253 PubMed Summary | CrossRef Full Textual content | Google Scholar
7. Tsigalou C, Konstantinidis T, Stavropoulou E, Bezirtzoglou EE, Tsakris A. Potential elimination of human intestine resistome by exploiting the advantages of purposeful meals. Entrance Microbiol. (2020) 11:50. doi: 10.3389/fmicb.2020.00050 PubMed Summary | CrossRef Full Textual content | Google Scholar
8. Wieers G, Belkhir L, Enaud R, Leclercq S, de Foy JMP, Dequenne I, et al. How probiotics have an effect on the microbiota. Entrance Cell Infect Microbiol. (2019) 9:454. doi: 10.3389/fcimb.2019.00454 PubMed Summary | CrossRef Full Textual content | Google Scholar
10. Soltan Dallal MM, Davoodabadi A, Abdi M, Hajiabdolbaghi M, Sharifi Yazdi MK, Douraghi M, et al. Inhibitory impact of Lactobacillus plantarum and Lb. fermentum remoted from the faeces of wholesome infants towards nonfermentative micro organism inflicting nosocomial infections. New Microbes New Infect. (2017) 15:9–13. doi: 10.1016/j.nmni.2016.09.003 PubMed Summary | CrossRef Full Textual content | Google Scholar
11. Ljungquist O, Kampmann C, Resman F, Riesbeck Okay, Tham J. Probiotics for intestinal decolonization of ESBL-producing Enterobacteriaceae: a randomized, placebo-controlled scientific trial. Clin Microbiol Infect. (2020) 26:456–62. doi: 10.1016/j.cmi.2019.08.019 PubMed Summary | CrossRef Full Textual content | Google Scholar
12. Ubeda C, Bucci V, Caballero S, Djukovic A, Toussaint NC, Equinda M, et al. Intestinal microbiota containing Barnesiella species cures vancomycin-resistant Enterococcus faecium colonization. Infect Immun. (2013) 81:965–73. doi: 10.1128/IAI.01197-12 PubMed Summary | CrossRef Full Textual content | Google Scholar
13. Tannock GW, Munro Okay, Harmsen HJ, Welling GW, Good J, Gopal PK. Evaluation of the fecal microflora of human topics consuming a probiotic product containing Lactobacillus rhamnosus DR20. Appl Environ Microbiol. (2000) 66:2578–88. doi: 10.1128/AEM.66.6.2578-2588.2000 PubMed Summary | CrossRef Full Textual content | Google Scholar
14. Crouzet L, Derrien M, Cherbuy C, Plancade S, Foulon M, Chalin B, et al. Lactobacillus paracasei CNCM I-3689 reduces vancomycin-resistant Enterococcus persistence and promotes Bacteroidetes resilience within the intestine following antibiotic problem. Sci Rep. (2018) 8:5098. doi: 10.1038/s41598-018-23437-9 PubMed Summary | CrossRef Full Textual content | Google Scholar
15. Plummer SF, Garaiova I, Sarvotham T, Cottrell SL, Scouiller SL, Weaver MA, et al. Results of probiotics on the composition of the intestinal microbiota following antibiotic remedy. Int J Antimicrob Brokers. (2005) 26:69–74. doi: 10.1016/j.ijantimicag.2005.04.004 PubMed Summary | CrossRef Full Textual content | Google Scholar
16. Rubio-Gomez JM, Santiago CM, Udaondo Z, Garitaonaindia MT, Krell T, Ramos JL, et al. Full transcriptomic response of Pseudomonas aeruginosa to an inulin-derived fructooligosaccharide. Entrance Microbiol. (2020) 11:202. doi: 10.3389/fmicb.2020.00202 PubMed Summary | CrossRef Full Textual content | Google Scholar
18. Bulow C, Langdon A, Hink T, Wallace M., Reske KA, Patel S, et al. Influence of amoxicillin-clavulanate adopted by autologous fecal microbiota transplantation on fecal microbiome construction and metabolic potential. mSphere. (2018) 3:1–13. doi: 10.1128/mSphereDirect.00588-18 PubMed Summary | CrossRef Full Textual content | Google Scholar
20. Valdez JC, Peral MC, Rachid M, Santana M, Perdigon G. Interference of Lactobacillus plantarum with Pseudomonas aeruginosa in vitro and in contaminated burns: the potential use of probiotics in wound therapy. Clin Microbiol Infect. (2005) 11:472–9. doi: 10.1111/j.1469-0691.2005.01142.x PubMed Summary | CrossRef Full Textual content | Google Scholar
21. Forestier C, Guelon D, Cluytens V, Gillart T, Sirot J, De Champs C. Oral probiotic and prevention of Pseudomonas aeruginosa infections: a randomized, double-blind, placebo-controlled pilot examine in intensive care unit sufferers. Crit Care. (2008) 12:R69. doi: 10.1186/cc6907 PubMed Summary | CrossRef Full Textual content | Google Scholar