ArticleThe European respiratory journal2023
In critically ill patients, anti-anaerobic antibiotics increase risk of adverse clinical outcomes.
Article in The European respiratory journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 74 papers, 1 of them a synthesis that pooled it.
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Who cites it
74 citing papers in PubMed, 1 synthesis or guideline pooled it, 123 citations in OpenAlex.
- Difference analysis of intestinal microbiota in patients in the intensive care unit using different sampling methods: a systematic review and meta-analysis.Frontiers in microbiology · 2025Pooled it
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- Gut Colonization With Vancomycin-Resistant Enterococcus Shapes the Gut Microbiome in the Intensive Care Unit.The Journal of infectious diseases · 2025Trial
- Effects of Tanreqing injection on the gut microbiota in healthy volunteers.Frontiers in cellular and infection microbiology · 2024Trial
- Myeloid cell reprogramming drives enhanced defense againstProceedings of the National Academy of Sciences of the United States of America · 2026Article
- Review
- Short-Chain Fatty Acids in Sepsis: Mechanisms of Action and Therapeutic Advances.Biomedicines · 2026Review
- Advances in ventilator-associated pneumonia: from pathophysiology to precision management.Intensive care medicine · 2026Article
- Feasibility and Safety of Washed Microbiota Transplantation as Salvage Therapy for Refractory Non-CDI Gut Pathogens in Critically Ill Patients.Microbial biotechnology · 2026Article
- Association of Timely Antibiotics and Fluid Resuscitation With Increased Discharge to Home After Sepsis.Chest · 2026Observational
- Microbial and immune determinants of disease severity and death in pediatric pneumonia.medRxiv : the preprint server for health sciences · 2026Article
- The Role of the Respiratory Microbiome in Pneumonia.Clinics in chest medicine · 2026Review
- Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026.Intensive care medicine · 2026Article
- Pathogen characteristics are key determinants of distinct host response phenotypes of sepsis.The Journal of clinical investigation · 2026Observational
- Functional CFTR may be required for Prevotella melaninogenica regulation of epithelial cell defense against Staphylococcus aureus.Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society · 2026Article
- Prevention and management of febrile neutropenia in acute myeloid leukaemia and higher risk myelodysplastic syndrome: An international survey of current practice.British journal of haematology · 2026Article
- Gastrointestinal axis in post-traumatic sepsis: from molecular mechanisms to translational perspectives.Frontiers in immunology · 2026Review
- Decoding the gut interactome after severe trauma: from molecular dialogue to integrative treatment strategies.Frontiers in microbiology · 2026Review
- Improving Critical Thinking and Nursing Outcomes Through an Evidence-Based Nutritional Protocol in Critically Ill Patients: A Quasi-Experimental Study.Journal of multidisciplinary healthcare · 2026Article
14 more citing papers are in PubMed but not listed here.
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14 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundCritically ill patients routinely receive antibiotics with activity against anaerobic gut bacteria. However, in other disease states and animal models, gut anaerobes are protective against pneumonia, organ failure and mortality. We therefore designed a translational series of analyses and experiments to determine the effects of anti-anaerobic antibiotics on the risk of adverse clinical outcomes among critically ill patients.
methodsWe conducted a retrospective single-centre cohort study of 3032 critically ill patients, comparing patients who did and did not receive early anti-anaerobic antibiotics. We compared intensive care unit outcomes (ventilator-associated pneumonia (VAP)-free survival, infection-free survival and overall survival) in all patients and changes in gut microbiota in a subcohort of 116 patients. In murine models, we studied the effects of anaerobe depletion in infectious (
resultsEarly administration of anti-anaerobic antibiotics was associated with decreased VAP-free survival (hazard ratio (HR) 1.24, 95% CI 1.06-1.45), infection-free survival (HR 1.22, 95% CI 1.09-1.38) and overall survival (HR 1.14, 95% CI 1.02-1.28). Patients who received anti-anaerobic antibiotics had decreased initial gut bacterial density (p=0.00038), increased microbiome expansion during hospitalisation (p=0.011) and domination by Enterobacteriaceae spp. (p=0.045). Enterobacteriaceae were also enriched among respiratory pathogens in anti-anaerobic-treated patients (p<2.2×10
conclusionsIn critically ill patients, early treatment with anti-anaerobic antibiotics is associated with increased mortality. Mechanisms may include enrichment of the gut with respiratory pathogens, but increased mortality is incompletely explained by infections alone. Given consistent clinical and experimental evidence of harm, the widespread use of anti-anaerobic antibiotics should be reconsidered.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.