Research Article

Deciphering the effect of maternal postpartum antibiotic prophylaxis on the infant gut microbiome: a whole metagenomic analysis

Department of Pathogen Biology, Rajiv Gandhi Center for Biotechnology, Thiruvananthapuram, Kerala, 695014, India

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Devika J Das

Department of Pathogen Biology, Rajiv Gandhi Center for Biotechnology, Thiruvananthapuram, Kerala, 695014, India

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Seema Nayar

Department of Microbiology, Government Medical College, Thiruvananthapuram, Kerala, 695011, India

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Sabu Thomas

*Author for correspondence: Tel.: +91 471 252 9521;

E-mail Address: sabu@rgcb.res.in

https://orcid.org/0000-0002-7634-8930

Department of Pathogen Biology, Rajiv Gandhi Center for Biotechnology, Thiruvananthapuram, Kerala, 695014, India

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Published Online:19 May 2023https://doi.org/10.2217/fmb-2022-0200

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Abstract

Aim: To analyze the impact of postpartum antibiotic (Ab) prophylaxis on the infant gut microbiome. Materials & methods: Whole metagenomic analysis was performed on breast milk and infant fecal samples collected from mother–infant pairs who belonged to two groups: an Ab group comprising mothers who had received a single course of Abs in the immediate postpartum period and a non-Ab group comprising mothers who had not received Abs. Results: The characteristic presence of Citrobacter werkmanii, an emerging multidrug-resistant uropathogen, and a higher relative abundance of genes encoding resistance to specific Abs were noted in samples from the Ab group compared with those from the non-Ab group. Conclusion: Policies regarding prophylactic Ab prescription across government and private health sectors in the postpartum period need to be strengthened.

Plain language summary

We studied the impact of antibiotics (Abs) that were taken by mothers as a preventive measure in the immediate postdelivery period on the bacterial diversity of the infant gut. All mother–infant pairs who participated in the study had undergone ‘low-risk’, normal delivery and practiced exclusive breastfeeding. Stool samples of the infants and breast milk samples of the corresponding mothers were collected for analysis of the pattern of microbial composition. On analysis, it was found that stool samples of the infants in the Ab group comprised opportunistic pathogens and harbored genes encoding resistance to specific Abs. There was a relatively higher abundance of beneficial bacteria in infant stool samples of the non-Ab group. This study highlights the need to reconsider the existing practice of taking Abs as a preventive measure after normal delivery to maintain health and reduce the spread of antimicrobial resistance in this particular region.

Tweetable abstract

We investigated the impact of maternal postpartum antibiotic prophylaxis on the infant gut microbiome subsequent to vaginal delivery. Based on the results gathered, we suggest the need to reframe the existing antimicrobial resistance strategy in the postpartum period.

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Papers of special note have been highlighted as: • of interest

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Vol. 18, No. 7

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History

Received 3 September 2022

Accepted 9 March 2023

Published online 19 May 2023

Published in print May 2023

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Keywords

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.futuremedicine.com/doi/suppl/10.2217/fmb-2022-0200

Author contributions

A Shankar and S Thomas conceived the study and designed the experiments. A Shankar and DJ Das interpreted the results. A Shankar drafted the manuscript. S Nayar and S Thomas reviewed the manuscript. S Thomas approved the final manuscript.

Acknowledgments

The authors thank C Narayana, Director of the Rajiv Gandhi Center for Biotechnology, for the support and facilities provided and Metropolitan Hospital, Thrissur, Kerala and other hospitals that provided samples for the study.

Financial & competing interests disclosure

This study was supported by the Department of Health and Family Welfare, Government of Kerala, India (AC1-250/2018/SPHCL). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The study was approved by the ethics committee of the Rajiv Gandhi Center for Biotechnology (IHEC1/2015/12), and signed consent forms along with clinical metadata sheets were collected from all mothers for the purpose of documentation.

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