Risk of subsequent sepsis (in people) within 90 days after a hospital stay is strongly influenced by antibiotic exposure
Broadly-speaking, it’s a bit easier these days to persuade pet-owners that antibiotics may not always be necessary, I still feel, however, that the potential negative effects are widely under-appreciated. Certainly, with clients, I always feel that they see the main reason to avoid antibiotics as helping avoid resistance in the population as a whole.
The consequences of messing with gut flora often play out over months and years; with the result that the link between antibiotic-use and bad outcomes isn’t obvious to owners or vets. It’s only revealed with population studies.
One more piece of research to quote to clients and colleagues then:
Clin Infect Dis . 2018 Mar 19;66(7):1004-101
Risk of Subsequent Sepsis Within 90 Days After a Hospital Stay by Type of Antibiotic Exposure
James Baggs, John A Jernigan, Alison Laufer Halpin, Lauren Epstein, Kelly M Hatfield, L Clifford McDonald
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909479/
This ‘study identified an increased risk of sepsis within 90 days of discharge among patients with exposure to high risk or increased quantities of antibiotics during hospitalization. Given a significant proportion of inpatient antimicrobial use may be unnecessary, this study builds on previous evidence suggesting that increased stewardship efforts in hospitals may not only prevent antimicrobial resistance, CDI and other adverse effects, but also reduce unwanted outcomes potentially related to disruption of the microbiota, including sepsis‘
Their ‘high risk’ antibiotics were:
- 3rd/4th generation cephalosporins
- fluoroquinolones
- lincosamides
- beta-lactam/beta-lactamase inhibitor combinations
- oral vancomycin,
- carbapenems
Low risk exposures included receipt of 1st/2nd generation cephalosporins, macrolide, tetracycline, metronidazole, and sulfa antibiotics.
The authors also looked at a reference group without antibiotic exposure.
Encouragingly, ‘low risk’ antibiotics were not associated with significantly greater risk of sepsis when compared the ‘no antibiotic’ group. Risk of sepsis generally and of severe sepsis/septic shock both tripled after exposure to ‘high risk’ agents.
The other human medicine paper I find useful (I’d argue that the commonest situation of unnecessary antibiotic use is in acute or subacute diarrhoea in dogs and cats) is this one based on the Swedish national database:
Lancet Gastroenterol Hepatol. 2020 Nov; 5(11): 986–995.
Antibiotic use and the development of inflammatory bowel disease: a national case/control study in Sweden
Long H. Nguyen, M.D., Anne K. Örtqvist, M.D., Yin Cao, Sc.D., Tracey G. Simon, M.D., Bjorn Roelstraete, Mingyang Song, Sc.D., Amit D. Joshi, Ph.D., Kyle Staller, M.D., Andrew T. Chan, M.D., Professor, Hamed Khalili, M.D., Ola Olén, M.D., and Jonas F. Ludvigsson,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8034612/
‘Higher cumulative exposure to systemic antibiotic therapy, particularly those with greater spectrum of microbial coverage, may be associated with an increase in risk for new-onset IBD‘
Owners are happier to accept a no-antibiotic recommendation when they feel that it will potentially benefit their own pet’s health as compared to a wider-population benefit.
