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Research article
Xuanding Wang
Zhejiang University School of Medicine
Corresponding Author
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Background: There have been no systematic studies of microbiological differences before and after antibiotics treatment. The aim of this study was to evaluate the effect of prior receipt of antibiotics on the microorganism distribution.
Methods: A retrospective, observational cohort study was conducted in a 3 200-bed tertiary, referral, teaching hospital in eastern China. During a 2-year period, all hospitalized patients treated with antimicrobial agents were enrolled in this study. Among 48 692 patients evaluated, the 27 792 (57.1%) who were sampled within two days before or after administration of the first dose of antimicrobial agents were included. Distribution of clinical specimens and the microorganism were compared between before and after antibiotic drug treatment groups.
Results: Compared to specimens taken after antibiotics exposure, specimens taken before antibiotics exposure had a higher proportion of blood and urine specimens and a higher culture positive rate (all P<0.001). Higher percentages of Staphylococcus aureus (9.9% vs. 8.5%, P=0.041), non-fermenting bacteria (27.7% vs. 19.9%, P<0.001), and fungi 8.4% vs. 4.0%, P<0.001) were isolated from the group after antibiotics exposure, while the percentages of Streptococcus spp. (4.8% vs. 2.7%, P<0.001), Haemophilus influenzae (2.3% vs. 0.8%, P<0.001), and Moraxella catarrhalis (0.7% vs. 0.1%, P<0.001) were higher in the group before antibiotics exposure. Further analysis found significant differences of microbes derived from respiratory secretions, blood or urine samples. We found, after antibiotics exposure, the separation rate of non-fermenting bacteria was significantly increased (all P < 0.05), and the separation rate of Candida spp. was higher, with statistical significance in airway secretion and urine samples (both P < 0.05), but the separation rate of Staphylococcus aureus among the three groups was not affected by antibiotics. In addition, the isolation rate of Streptococcus spp. in blood and urine samples decreased significantly (both P < 0.05) after antibiotics exposure. Interestingly, no statistical difference was found for microbes isolated from body fluid specimens between the two groups.
Conclusions: The outcome revealed that antibiotic-insensitive organisms such as non-fermentative bacteria and fungi were more frequently isolated after antibiotics exposure. However, this trend might be specimen dependent and was not obvious in body fluid specimens.
Keywords
clinical specimen, microorganism distribution, antimicrobial stewardship
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CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
Version 2
Posted 10 Dec, 2019
No community comments so far
Editorial decision: Accept
On 15 Dec, 2019
Review #2 received
Received 10 Dec, 2019
Reviewer #2 agreed
On 09 Dec, 2019
Reviewers invited
Invitations sent on 03 Dec, 2019
Reviewer #1 agreed
On 03 Dec, 2019
Review #1 received
Received 03 Dec, 2019
Editor assigned
On 02 Dec, 2019
Submission checks complete
On 01 Dec, 2019
Editor invited
On 01 Dec, 2019
No comments provided
Editorial decision: Major revision
On 25 Oct, 2019
Review #2 received
Received 23 Oct, 2019
Reviewer #2 agreed
On 07 Oct, 2019
Review #1 received
Received 04 Oct, 2019
Reviewers invited
Invitations sent on 20 Sep, 2019
Reviewer #1 agreed
On 20 Sep, 2019
Submission checks complete
On 17 Sep, 2019
Editor assigned
On 17 Sep, 2019
Editor invited
On 16 Sep, 2019
First submitted
On 14 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
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A new preprint design is coming!
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See the published version of this preprint at BMC Infectious Diseases.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Xuanding Wang
Zhejiang University School of Medicine
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
Version 2
Posted 10 Dec, 2019
No community comments so far
Editorial decision: Accept
On 15 Dec, 2019
Review #2 received
Received 10 Dec, 2019
Reviewer #2 agreed
On 09 Dec, 2019
Reviewers invited
Invitations sent on 03 Dec, 2019
Reviewer #1 agreed
On 03 Dec, 2019
Review #1 received
Received 03 Dec, 2019
Editor assigned
On 02 Dec, 2019
Submission checks complete
On 01 Dec, 2019
Editor invited
On 01 Dec, 2019
No comments provided
Editorial decision: Major revision
On 25 Oct, 2019
Review #2 received
Received 23 Oct, 2019
Reviewer #2 agreed
On 07 Oct, 2019
Review #1 received
Received 04 Oct, 2019
Reviewers invited
Invitations sent on 20 Sep, 2019
Reviewer #1 agreed
On 20 Sep, 2019
Submission checks complete
On 17 Sep, 2019
Editor assigned
On 17 Sep, 2019
Editor invited
On 16 Sep, 2019
First submitted
On 14 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Infectious Diseases.
Background: There have been no systematic studies of microbiological differences before and after antibiotics treatment. The aim of this study was to evaluate the effect of prior receipt of antibiotics on the microorganism distribution.
Methods: A retrospective, observational cohort study was conducted in a 3 200-bed tertiary, referral, teaching hospital in eastern China. During a 2-year period, all hospitalized patients treated with antimicrobial agents were enrolled in this study. Among 48 692 patients evaluated, the 27 792 (57.1%) who were sampled within two days before or after administration of the first dose of antimicrobial agents were included. Distribution of clinical specimens and the microorganism were compared between before and after antibiotic drug treatment groups.
Results: Compared to specimens taken after antibiotics exposure, specimens taken before antibiotics exposure had a higher proportion of blood and urine specimens and a higher culture positive rate (all P<0.001). Higher percentages of Staphylococcus aureus (9.9% vs. 8.5%, P=0.041), non-fermenting bacteria (27.7% vs. 19.9%, P<0.001), and fungi 8.4% vs. 4.0%, P<0.001) were isolated from the group after antibiotics exposure, while the percentages of Streptococcus spp. (4.8% vs. 2.7%, P<0.001), Haemophilus influenzae (2.3% vs. 0.8%, P<0.001), and Moraxella catarrhalis (0.7% vs. 0.1%, P<0.001) were higher in the group before antibiotics exposure. Further analysis found significant differences of microbes derived from respiratory secretions, blood or urine samples. We found, after antibiotics exposure, the separation rate of non-fermenting bacteria was significantly increased (all P < 0.05), and the separation rate of Candida spp. was higher, with statistical significance in airway secretion and urine samples (both P < 0.05), but the separation rate of Staphylococcus aureus among the three groups was not affected by antibiotics. In addition, the isolation rate of Streptococcus spp. in blood and urine samples decreased significantly (both P < 0.05) after antibiotics exposure. Interestingly, no statistical difference was found for microbes isolated from body fluid specimens between the two groups.
Conclusions: The outcome revealed that antibiotic-insensitive organisms such as non-fermentative bacteria and fungi were more frequently isolated after antibiotics exposure. However, this trend might be specimen dependent and was not obvious in body fluid specimens.
Figure 1
Figure 2
Figure 3
Figure 4
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