Impact of antibiotics on off-target infant gut microbiota and resistance genes in cohort studies

Rebecca M. Lebeaux, Juliette C. Madan, Quang P. Nguyen, Modupe O. Coker, Erika F. Dade, Yuka Moroishi, Thomas J. Palys, Benjamin D. Ross, Melinda M. Pettigrew, Hilary G. Morrison, Margaret R. Karagas, Anne G. Hoen

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Young children are frequently exposed to antibiotics, with the potential for collateral consequences to the gut microbiome. The impact of antibiotic exposures to off-target microbes (i.e., bacteria not targeted by treatment) and antibiotic resistance genes (ARGs) is poorly understood. Methods: We used metagenomic sequencing data from paired stool samples collected prior to antibiotic exposure and at 1 year from over 200 infants and a difference-in-differences approach to assess the relationship between subsequent exposures and the abundance or compositional diversity of microbes and ARGs while adjusting for covariates. Results: By 1 year, the abundance of multiple species and ARGs differed by antibiotic exposure. Compared to infants never exposed to antibiotics, Bacteroides vulgatus relative abundance increased by 1.72% (95% CI: 0.19, 3.24) while Bacteroides fragilis decreased by 1.56% (95% CI: −4.32, 1.21). Bifidobacterium species also exhibited opposing trends. ARGs associated with exposure included class A beta-lactamase gene CfxA6. Among infants attending day care, Escherichia coli and ARG abundance were both positively associated with antibiotic use. Conclusion: Novel findings, including the importance of day care attendance, were identified through considering microbiome data at baseline and post-intervention. Thus, our study design and approach have important implications for future studies evaluating the unintended impacts of antibiotics. Impact: The impact of antibiotic exposure to off-target microbes and antibiotic resistance genes in the gut is poorly defined.We quantified these impacts in two cohort studies using a difference-in-differences approach. Novel to microbiome studies, we used pre/post-antibiotic data to emulate a randomized controlled trial.Compared to infants unexposed to antibiotics between baseline and 1 year, the relative abundance of multiple off-target species and antibiotic resistance genes was altered.Infants who attended day care and were exposed to antibiotics within the first year had a higher abundance of Escherichia coli and antibiotic resistance genes; a novel finding warranting further investigation.

Original languageEnglish (US)
Pages (from-to)1757-1766
Number of pages10
JournalPediatric Research
Issue number6
StatePublished - Dec 2022

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health


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