Date Published: June 22, 2018
Publisher: Public Library of Science
Author(s): Maiara Brusco de Freitas, Emilia Addison Machado Moreira, Camila Tomio, Yara Maria Franco Moreno, Felipe Perozzo Daltoe, Eliana Barbosa, Norberto Ludwig Neto, Vittoria Buccigrossi, Alfredo Guarino, Nades Palaniyar.
The aim of the present study was to evaluate the effect of cystic fibrosis and antibiotic therapy on intestinal microbiota composition and intestinal inflammation in children and adolescents. A cross-sectional controlled study was conducted with 36 children and adolescents: 19 in the cystic fibrosis group (CFG) and 17 in the control group (CG) matched for age and sex. The CFG was subdivided based on the use of antibiotic therapy (CFAB group) and non-use of antibiotic therapy (CFnAB group). The following data were evaluated: colonization, antibiotic therapy, mutation, breastfeeding, use of infant formula, type of delivery, introduction of solid foods, body mass index, fecal calprotectin and intestinal microbiota composition (fluorescence in situ hybridization). Intestinal inflammation evaluated by fecal calprotectin was significantly higher in the CFG (median: 40.80 µg/g, IQR: 19.80–87.10, p = 0.040) and CFAB group (median: 62.95 µg/g, IQR: 21.80–136.62, p = 0.045) compared to the CG (median: 20.15 µg/g, IQR: 16.20–31.00), and the Bacteroides, Firmicutes, Eubacterium rectale and Faecalibacterium prausnitzii were significantly decreased (p < 0.05) in the CFG compared to the CG, whereas the bacteria Clostridium difficile, Escherichia coli and Pseudomonas aeruginosa were significantly increased in the CFG (p < 0.05). The main differences were found between the CG and CFAB group for Eubacterium rectale (p = 0.006), Bifidobacterium (p = 0.017), Escherichia coli (p = 0.030), Firmicutes (p = 0.002), Pseudomonas aeruginosa (p < 0.001) and Clostridium difficile (p = 0.006). The results of this study confirm intestinal inflammation in patients with CF, which may be related to changes in the composition of the intestinal microbiota.
Microbiome acquisition begins in the uterus and progresses during childhood. The composition of the microbiota is influenced by the type of delivery, feeding, exposure to antibiotics in the perinatal period and maternal physical contact [1, 2]. An increase in the diversity of the intestinal microbiota occurs beginning at birth and children one to three years of age have a pattern similar to that found in adults. However, the occurrence of infection results in a lower diversity of microbiota [3, 4]. In addition to being associated with health promotion, breast milk provides significant amounts of Bifidobacterium and Lactobacillus  and the ingestion of solid foods may or may not exert a positive influence on the microbiome, depending on the type of food .
The required sample size calculated by the difference in means was 18 for each group (OpenEpi® program, 1:1 proportion of exposed to non-exposed, 80% power and 95% confidence level). Thus, the overall sample was composed of 36 children and adolescents. The control group (CG) was composed of 17 individuals with a median age of 3.00 years [interquartile range (IQR): 0.60–7.00 years] and cystic fibrosis group (CFG) was composed of 19 individuals with a median age of 4.00 years (IQR: 1.10–9.50 years). Moreover, the CFG was subdivided based on the use of antibiotic therapy (CFAB group) and non-use of antibiotic therapy (CFnAB group).
The literature reports intestinal abnormalities in the microbiota of patients with CF [6, 12, 24]. However, it is unclear whether this altered microbiota is the consequence of the disease or antibiotic therapy and the implications of these changes remain unknown. The present study shows a different pattern of bacterial species.