Rapid and Profound Shifts in the Vaginal Microbiota Following Antibiotic Treatment for Bacterial Vaginosis
Rapid and Profound Shifts in the Vaginal Microbiota Following Antibiotic Treatment for Bacterial Vaginosis
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DOI：
10.1093/infdis/jiv079
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发表时间：
2015-09-01
影响因子：
6.4
通讯作者：
Schiffer, Joshua T.
中科院分区：
文献类型：
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作者：
Mayer, Bryan T.;Srinivasan, Sujatha;Schiffer, Joshua T.
背景细菌性阴道病（BV）是一种常见的多种微生物疾病，与许多负面的生殖健康结果，包括人类免疫缺陷病毒获得的风险增加。BV可以用抗生素治疗，但复发很常见。对BV抗生素治疗期间细菌动力学的更详细了解可以确定有利于BV相关细菌种类建立、维持和根除的条件，从而改善治疗结果。我们使用数学模型分析每日定量测量的11个关键细菌菌种甲硝唑治疗15例BV。我们发现在开始治疗的一天内阴道细菌组成完全重组。尽管基线细菌水平预测清除时间较长，但所有厌氧菌种均在中位3天内迅速消除。然而，治疗停止后BV相关物种的重新出现是常见的。兼性厌氧微生物加德纳菌（Gardnerella vagulosa）的清除速度比厌氧BV相关菌慢，且G.治疗期间，迷走神经经常反弹。我们观察到乳酸菌逐渐生长，表明非靶向微生物填补了治疗期间形成的短暂真空。在抗生素的压力下，人体微生物组可以在数小时内迅速发生变化。当治疗停止时，BV相关细菌迅速重新出现，这表明间歇性预防性治疗可能发挥作用。
Background. Bacterial vaginosis (BV) is a common polymicrobial disease associated with numerous negative reproductive health outcomes, including an increased risk of human immunodeficiency virus acquisition. BV is treatable with antibiotics, but relapse is common. A more detailed understanding of bacterial dynamics during antibiotic therapy for BV could identify conditions that favor establishment, maintenance, and eradication of BV-associated bacterial species, thereby improving treatment outcomes.Methods. We used mathematical models to analyze daily quantitative measurements of 11 key bacterial species during metronidazole treatment for 15 cases of BV.Results. We identified complete reorganization of vaginal bacterial composition within a day of initiating therapy. Although baseline bacterial levels predicted a longer time to clearance, all anaerobic species were eliminated rapidly within a median of 3 days. However, reemergence of BV-associated species was common following treatment cessation. Gardnerella vaginalis, a facultative anaerobe, was cleared more slowly than anaerobic BV-associated species, and levels of G. vaginalis often rebounded during treatment. We observed gradual Lactobacillus species growth, indicating that untargeted microbes fill the transient vacuum formed during treatment.Conclusions. Under antibiotic pressure, the human microbiome can undergo rapid shifts on a scale of hours. When treatment is stopped, BV-associated bacteria quickly reemerge, suggesting a possible role for intermittent prophylactic treatment.