Impact of Antibiotic Stewardship on Gut Microbiome in Short Bowel Syndrome (SBS) Pediatric Patients

ntroduction: Patients with Short Bowel Syndrome (SBS) has alterations in anatomy and physiology that predispose to bacterial overgrowth, leading to gastrointestinal and systemic symptoms and mucosal alteration. Antimicrobial stewardship is the mainstay of therapy, but it remains largely empirical. The aim of the study is to demonstrate changes in the bacterial constituents of microbiome with different antimicrobial therapies. Methods: Stool specimens have been collected from SBS pediatric patients and stored at -20°C until DNA extraction (DNeasy PowerLyzer PowerSoil Kit). To explore changes in the Bacterial and Fungal community in relation to the different phases of antibiotic therapy, targeted metagenomics on the 16S rRNA gene and on the ITS region, respectively, was employed. Specimen also underwent chemical-physical analysis and short chain fatty acids content. Results: The study demonstrate that oral antibiotic therapy influences microbiome composition in its microbic and fungal communities and these changes relate to the length of treatment. The use of cyclical antibiotic stewardship avoids resistant species selection and can contributes to prevent bacterial overgrowth in SBS patients. Conclusions: We recommend the routinely use of faecal microbiome analysis in patients with high risk of dismicrobism to adapt the antibiotic therapy based on the bacterial communities detected