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Gastroenterology

Antibiotic resistance: the lung microbiota pays a heavy price

Antibiotic resistance
Pulmonology Gastroenterology Pediatrics

Broad-spectrum antibiotics used for treating lung infections are regarded as one of the principal contributors to the overall burden of antibiotic resistance.

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About this article

Created 25 August 2021
Updated 27 October 2023

Historically, the lungs of healthy individuals were considered sterile; the description of the LRT microbiota (Lower Respiratory Tract, from larynx to alveoli of the lungs)1 is a recent achievement.2,3 Along with viral and fungal communities, six bacterial phyla dominate a healthy lung microbiota: Firmicutes, Bacteroidetes, Fusobacteria, Proteobacteria, Acidobacteria, and Actinobacteria.1,2,4

“In Western populations, the treatment of lung infections is a primary driver of antibiotic resistance.4”

Antibiotics saved millions of lives but their misuse or oversuse now raises serious concerns for health, notably with the further emergence of antimicrobial resistance. Each year, the the World Health Organization (WHO) organizes the World AMR Awareness Week (WAAW) to increase awareness of this public health issue. Let’s take a look at this global threat that required urgent action:

Microbiota at the forefront of antibiotic resistance

The largescale and sometimes inappropriate use of antibiotics is making them in…

A loss of diversity in the lung microbiota

Microbial dysbiosis is observed in a range of respiratory disorders, including lung infection, asthma, chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF).5,6 But only few studies have explored the direct effects of antibiotics on lung microbiota. Recent investigation has shown that azithromycin treatment decreased bacterial diversity in patients with persistent uncontrolled asthma;1 however clinical benefits are still controversial.1,7,8 In COPD patients, azithromycin treatment lowered alpha diversity;1 in those suffering from CF, antibiotics appear to be the primary drivers of decreased airway microbiota diversity.5

The gut-lung axis

Respiratory diseases, chronic lung disorders and microbial infections are often accompanied by intestinal symptoms.12 Indeed, the intestinal ecosystem undergoes change during the course of several lung diseases.12 While the underling mechanism remains unclear, reciprocal influence between the gut and the lungs could, in part, explain why antibiotic-induced dysbiosis of the gut microbiota in early-life may be a risk factor for subsequent allergic rhinitis and asthma.1,12

The plague of broad-spectrum antibiotics

While the misuse of antibiotics is known to lead to the emergence and selection of resistant bacteria, antibiotic prophylaxis, without a microbial diagnosis, is still widely used to treat lung infections.4 Of the 12 antibiotic-resistant ‘priority pathogens’ listed by the WHO, 4 affect lungs: Pseudomonas aeruginosa, Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus aureus.4,9 There is agreement among the scientific community as a key route to minimize antimicrobial resistance that the disease management of lung infections needs to be improved.4,10,11

Promoting research, raising awareness

  • The Global Alliance Against Respiratory Diseases (GARD), launched by the WHO in 2006 to help combat chronic respiratory diseases, asserts: “Physicians worldwide now face situations in which infected patients cannot be treated adequately because the responsible bacterium is totally resistant to available antibiotics.11”

  • At the European level, the ERS (European Respiratory Society) is involved in promoting scientific research, providing access to resources and raising awareness among the public and political decision makers. “Science, education and advocacy are at the core of everything we do.” Its latest monograph, ‘The lung microbiome’,13 reviews the different components of the respiratory microbiome, examines how diseases (asthma, COPD, cancer…) emerge and discusses new developments and therapies.

What is the World AMR Awareness Week?

Each year, since 2015, the WHO organizes the World AMR Awareness Week (WAAW), which aims to increase awareness of global antimicrobial resistance. Held on 18-24 November, this campaign encourages the general public, healthcare professionals and decision-makers to use antimicrobials carefully, to prevent the further emergence of antimicrobial resistance.

Sources

1 Hufnagl K, Pali-Schöll I, Roth-Walter F, et al. Dysbiosis of the gut and lung microbiome has a role in asthma. Semin Immunopathol. 2020;42(1):75-93.

2 Barcik W, Boutin RCT, Sokolowska M, et al. The Role of Lung and Gut Microbiota in the Pathology of Asthma. Immunity. 2020;52(2):241-255.

3 Mathieu E, Escribano-Vazquez U, Descamps D, et al. Paradigms of Lung Microbiota Functions in Health and Disease, Particularly, in Asthma. Front Physiol. 2018;9:1168. Published 2018 Aug 21.

4 Cookson WOCM, Cox MJ, Moffatt MF. New opportunities for managing acute and chronic lung infections. Nat Rev Microbiol. 2018;16(2):111-120.

5 Zhao J, Schloss PD, Kalikin LM, et al. Decade-long bacterial community dynamics in cystic fibrosis airways. Proc Natl Acad Sci U S A. 2012;109(15):5809-5814.

6 Chung KF, Huffnagle GB, Huang YJ. The lung microbiome in obstructive airways disease: potential pathogenetic roles. In: Cox MJ, Ege MJ, von Mutius E, eds. The Lung Microbiome 2019 (ERS Monograph). Sheffield, European.

7 Gibson PG, Yang IA, Upham JW, et al. Efficacy of azithromycin in severe asthma from the AMAZES randomised trial. ERJ Open Res. 2019;5(4):00056-2019. Published 2019 Dec 23.

8 Chung KF. Airway microbial dysbiosis in asthmatic patients: A target for prevention and treatment?. J Allergy Clin Immunol. 2017;139(4):1071- 1081.

9 WHO. Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics. 25 february 2017

10 Lim WS, Baudouin SV, George RC, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009 Thorax 2009;64:iii1-iii55.

11 Forum of International Respiratory Societies. The Global Impact of Respiratory Disease – Second Edition. Sheffield, European Respiratory Society, 2017.

12 Marsland BJ, Trompette A, Gollwitzer ES. The Gut-Lung Axis in Respiratory Disease. Ann Am Thorac Soc. 2015;12 Suppl 2:S150-S156.

13 The Lung Microbiome. Edited by Cox MJ, Ege MJ, and von Mutius E. 2019. Monograph of European Respiratory Society.

Tags
Otitis Probiotics AAD Antibiotics WAAW World Antimicrobial Awareness Week Dysbiosis Public health Microbiome Flora

    See also

    Actu PRO : Antibiotiques et microbiote intestinal : quels impacts sur le long terme ? What are the long-term effects of antibiotics on the gut microbiota?
    Antibiotics: Dr Jekyll and Mr Hyde
    Focus
    The Janus face of Antibiotics: Life Savers & Microbiota Disrupters
    • Introduction
      • The Janus face of Antibiotics: Life Savers and Microbiota Disruptors
    • Gut
      • From diarrhea to chronic diseases: the well-documented consequences of antibiotic-related gut microbiota dysbiosis
    • Urogenital
      • Urogenital microbiota: the spectrum of mycosis or urinary tract infections after each antibiotic treatment
    • Cutaneous
      • Antibiotics, a double-edged sword when managing skin disease
    • ENT
      • Ears, Nose and Throat microbiota: when antibiotics challenge our first line of defense
    • Lung
      • Antibiotic resistance: the lung microbiota pays a heavy price
    • Conclusion
      • What to take away?
    Created 25 August 2021
    Updated 27 October 2023

    About this article

    To know more about this topic.

    Main topic

    Antibiotic resistance

    Medical practice

    Pulmonology Gastroenterology Pediatrics

    Content type

    Dossier detail
    Ears, Nose and Throat microbiota: when antibiotics challenge our first line of defense
    What to take away?
    Focus

    The Janus face of Antibiotics: Life Savers & Microbiota Disrupters

    Introduction

    The Janus face of Antibiotics: Life Savers and Microbiota Disruptors

    Gut

    From diarrhea to chronic diseases: the well-documented consequences of antibiotic-related gut microbiota dysbiosis

    Urogenital

    Urogenital microbiota: the spectrum of mycosis or urinary tract infections after each antibiotic treatment

    Cutaneous

    Antibiotics, a double-edged sword when managing skin disease

    ENT

    Ears, Nose and Throat microbiota: when antibiotics challenge our first line of defense

    Lung

    Antibiotic resistance: the lung microbiota pays a heavy price

    Conclusion

    What to take away?

    Continue reading

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