To assess whether dietary sugar intake during antibiotic treatment is associated with gut microbiome disruption in allogeneic hematopoietic cell transplantation (HCT) patients, and to test the diet–antibiotic interaction in mice.
Approach:
Human study: Prospective observational study of 173 adult HCT patients at one center (2017–2022), using recorded hospital meals and longitudinal stool samples. Bayesian analyses examined recent diet, antibiotic exposure, microbiome diversity and composition, and mortality.
Mouse experiment: Researchers compared enterococcal expansion after biapenem with and without sucrose supplementation.
Key Findings:
Among 1,009 stool samples from 158 patients, broad-spectrum antibiotic exposure in the prior 2 days was associated with lower microbiome alpha-diversity.
Sweets intake alone was not associated with alpha-diversity, but higher sweets or sugar intake during broad-spectrum antibiotic exposure was associated with further decreases. Model estimates indicated an additional 24% decrease per 100 g of sweets and 21% per…
Higher sweets intake after broad-spectrum antibiotic exposure was associated with increased Enterococcus faecium abundance.
Among patients with above-median sugar intake, each additional day of broad-spectrum antibiotic exposure was associated with a 12% higher mortality hazard; this association was not statistically significant in the below-median group. The authors noted that low…
In mice, sucrose supplementation increased antibiotic-associated enterococcal expansion 16.3-fold on day 3 and 33.4-fold on day 6 compared with antibiotic exposure without sucrose. Sucrose did not increase enterococci without antibiotic exposure.
Interpretation:
The human observational findings and mouse experiment suggest that simple sugars may amplify antibiotic-associated microbiome disruption. The authors stated that prospective studies are needed to determine whether reducing sugar intake preserves the microbiome or improves clinical outcomes.
Limitations:
The human study was observational and conducted at a single center in allogeneic HCT patients.
Near-universal prophylactic fluoroquinolone use means the findings may relate more specifically to dietary intake during escalation to broad-spectrum antibiotics.
Broad-spectrum antibiotics were initiated for clinical indications, so illness severity may have confounded associations.
Food consumed outside the hospital was incompletely captured, and treatment-related symptoms could have affected diet and other time-varying factors.
Conclusion:
The study reported an association between higher sugar intake during broad-spectrum antibiotic exposure and greater microbiome disruption in HCT patients, with supporting experimental findings in mice.
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More than 5,100 additional reports require further analysis as federal and state partners investigate several outbreaks and work to identify their sources.
