Evidence map›Paper›PMID 42856639›Full record

ArticlemedRxiv : the preprint server for health sciences2026

Coming Into Resistance: Clinically Important Antibiotic Resistance Genes in NICU vs. Healthy Infants.

Rachel E Strength, Angelina Angelova, Emily Robbins, Shira Levy, Kathryn E McCauley, Kevin M Lloyd, Elisa B Margolis, Andrew S Burns, Shreni Mistry, Poorani Subramanian and 17 more

Abstract readPreprint
PubMed Full text at PMC Publisher
In one paragraph

Article in medRxiv : the preprint server for health sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

27 authors.

Rachel E StrengthClinical Microbiome Unit, Laboratory of Host Immunity and Microbiome, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (Rachel E. Strength, MD; Emily Robbins, DO; Shira Levy, MA; Victor I. Band, PhD; Sivaranjani Namasivayam, PhD; Qing Chen, PhD; Katherine Rees, BS; Mickayla Bacorn, BS; Ruhika Prasad, BS; Phoebe LaPoint, BS; Hector N. Romero-Soto, BS; Suchitra K. Hourigan, MD).
Angelina AngelovaBioinformatics and Computational Biosciences Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (Angelina Angelova, PhD; Kathryn E. McCauley, MPH; Poorani Subramanian, PhD).
Emily RobbinsClinical Microbiome Unit, Laboratory of Host Immunity and Microbiome, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (Rachel E. Strength, MD; Emily Robbins, DO; Shira Levy, MA; Victor I. Band, PhD; Sivaranjani Namasivayam, PhD; Qing Chen, PhD; Katherine Rees, BS; Mickayla Bacorn, BS; Ruhika Prasad, BS; Phoebe LaPoint, BS; Hector N. Romero-Soto, BS; Suchitra K. Hourigan, MD).
Shira LevyClinical Microbiome Unit, Laboratory of Host Immunity and Microbiome, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (Rachel E. Strength, MD; Emily Robbins, DO; Shira Levy, MA; Victor I. Band, PhD; Sivaranjani Namasivayam, PhD; Qing Chen, PhD; Katherine Rees, BS; Mickayla Bacorn, BS; Ruhika Prasad, BS; Phoebe LaPoint, BS; Hector N. Romero-Soto, BS; Suchitra K. Hourigan, MD).
Kathryn E McCauleyBioinformatics and Computational Biosciences Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (Angelina Angelova, PhD; Kathryn E. McCauley, MPH; Poorani Subramanian, PhD).
Kevin M LloydDivision of Infectious Diseases, Children's National Hospital, Washington, DC, USA (Kevin M. Lloyd, MD; Craig Shapiro, MD; Rana F. Hamdy, MD, MPH, MSCE).
Elisa B MargolisDepartment of Pediatrics, Program in Molecular Medicine; University of Utah, Salt Lake City, UT, USA (Elisa B. Margolis, MD, PhD).
Andrew S BurnsNIAID Microbiome Program, Laboratory of Host Immunity and Microbiome, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (Andrew S. Burns, PhD; Shreni Mistry, PhD).
Shreni MistryNIAID Microbiome Program, Laboratory of Host Immunity and Microbiome, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (Andrew S. Burns, PhD; Shreni Mistry, PhD).
Poorani SubramanianBioinformatics and Computational Biosciences Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (Angelina Angelova, PhD; Kathryn E. McCauley, MPH; Poorani Subramanian, PhD).
Aimee DassnerDecera Clinical Education, Reston, VA, USA; Aimee Dassner conducted this work while affiliated with Children's National Hospital (Aimee Dassner, PharmD).
Christa ZerbeLaboratory of Clinical Immunology & Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (Christa Zerbe, MD).
Victor I BandClinical Microbiome Unit, Laboratory of Host Immunity and Microbiome, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (Rachel E. Strength, MD; Emily Robbins, DO; Shira Levy, MA; Victor I. Band, PhD; Sivaranjani Namasivayam, PhD; Qing Chen, PhD; Katherine Rees, BS; Mickayla Bacorn, BS; Ruhika Prasad, BS; Phoebe LaPoint, BS; Hector N. Romero-Soto, BS; Suchitra K. Hourigan, MD).
Sivaranjani NamasivayamClinical Microbiome Unit, Laboratory of Host Immunity and Microbiome, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (Rachel E. Strength, MD; Emily Robbins, DO; Shira Levy, MA; Victor I. Band, PhD; Sivaranjani Namasivayam, PhD; Qing Chen, PhD; Katherine Rees, BS; Mickayla Bacorn, BS; Ruhika Prasad, BS; Phoebe LaPoint, BS; Hector N. Romero-Soto, BS; Suchitra K. Hourigan, MD).
Qing ChenClinical Microbiome Unit, Laboratory of Host Immunity and Microbiome, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (Rachel E. Strength, MD; Emily Robbins, DO; Shira Levy, MA; Victor I. Band, PhD; Sivaranjani Namasivayam, PhD; Qing Chen, PhD; Katherine Rees, BS; Mickayla Bacorn, BS; Ruhika Prasad, BS; Phoebe LaPoint, BS; Hector N. Romero-Soto, BS; Suchitra K. Hourigan, MD).
Esther EsadahDepartment of Pharmacy, Children's National Hospital, Washington, DC, USA (Esther Esadah, PharmD).
Katherine ReesClinical Microbiome Unit, Laboratory of Host Immunity and Microbiome, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (Rachel E. Strength, MD; Emily Robbins, DO; Shira Levy, MA; Victor I. Band, PhD; Sivaranjani Namasivayam, PhD; Qing Chen, PhD; Katherine Rees, BS; Mickayla Bacorn, BS; Ruhika Prasad, BS; Phoebe LaPoint, BS; Hector N. Romero-Soto, BS; Suchitra K. Hourigan, MD).
Mickayla BacornClinical Microbiome Unit, Laboratory of Host Immunity and Microbiome, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (Rachel E. Strength, MD; Emily Robbins, DO; Shira Levy, MA; Victor I. Band, PhD; Sivaranjani Namasivayam, PhD; Qing Chen, PhD; Katherine Rees, BS; Mickayla Bacorn, BS; Ruhika Prasad, BS; Phoebe LaPoint, BS; Hector N. Romero-Soto, BS; Suchitra K. Hourigan, MD).
Ruhika PrasadClinical Microbiome Unit, Laboratory of Host Immunity and Microbiome, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (Rachel E. Strength, MD; Emily Robbins, DO; Shira Levy, MA; Victor I. Band, PhD; Sivaranjani Namasivayam, PhD; Qing Chen, PhD; Katherine Rees, BS; Mickayla Bacorn, BS; Ruhika Prasad, BS; Phoebe LaPoint, BS; Hector N. Romero-Soto, BS; Suchitra K. Hourigan, MD).
Phoebe LaPointClinical Microbiome Unit, Laboratory of Host Immunity and Microbiome, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (Rachel E. Strength, MD; Emily Robbins, DO; Shira Levy, MA; Victor I. Band, PhD; Sivaranjani Namasivayam, PhD; Qing Chen, PhD; Katherine Rees, BS; Mickayla Bacorn, BS; Ruhika Prasad, BS; Phoebe LaPoint, BS; Hector N. Romero-Soto, BS; Suchitra K. Hourigan, MD).
Hector N Romero-SotoClinical Microbiome Unit, Laboratory of Host Immunity and Microbiome, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (Rachel E. Strength, MD; Emily Robbins, DO; Shira Levy, MA; Victor I. Band, PhD; Sivaranjani Namasivayam, PhD; Qing Chen, PhD; Katherine Rees, BS; Mickayla Bacorn, BS; Ruhika Prasad, BS; Phoebe LaPoint, BS; Hector N. Romero-Soto, BS; Suchitra K. Hourigan, MD).
John P DekkerBacterial Pathogenesis and Antimicrobial Resistance Section, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (John P. Dekker, MD, PhD).
Cynthia L SearsDivision of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA (Cynthia L. Sears, MD).
Craig ShapiroDivision of Infectious Diseases, Children's National Hospital, Washington, DC, USA (Kevin M. Lloyd, MD; Craig Shapiro, MD; Rana F. Hamdy, MD, MPH, MSCE).
Rana F HamdyDivision of Infectious Diseases, Children's National Hospital, Washington, DC, USA (Kevin M. Lloyd, MD; Craig Shapiro, MD; Rana F. Hamdy, MD, MPH, MSCE).
Joseph M CamposDepartment of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA (Kevin M. Lloyd, MD; Craig Shapiro, MD; Rana F. Hamdy, MD; Joseph M. Campos, PhD).
Suchitra K HouriganClinical Microbiome Unit, Laboratory of Host Immunity and Microbiome, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (Rachel E. Strength, MD; Emily Robbins, DO; Shira Levy, MA; Victor I. Band, PhD; Sivaranjani Namasivayam, PhD; Qing Chen, PhD; Katherine Rees, BS; Mickayla Bacorn, BS; Ruhika Prasad, BS; Phoebe LaPoint, BS; Hector N. Romero-Soto, BS; Suchitra K. Hourigan, MD).

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Importance: Antibiotic-resistant infections in neonates often arise from the infant's own colonizing bacteria harboring antibiotic resistance genes (ARG). This study evaluates ARG that impact antibiotic selection and drive resistance-related mortality, termed clinically important antibiotic resistance genes (CI-ARG). Objective: To determine differences in gut CI-ARG abundance in children from birth through 3 years old, stratified by neonatal intensive care unit (NICU) admission and antibiotic (abx) exposure in the first two months. Design: Cohort study (sequencing, analysis completed 2025-2026) using shotgun metagenomic sequencing of stool samples from infants in two studies: "Neonatal Intestinal Microbiome" (+NICU groups, 2015-2022), "The First 1000 Days of Life and Beyond" (-NICU groups, 2018-2021). Infants grouped into four cohorts: +NICU/+abx, +NICU/-abx, -NICU/-abx, and -NICU/+abx. Prespecified CI-ARG abundance compared longitudinally among groups. Setting: NICU, well-baby nursery, Inova Fairfax Hospital, Virginia. Participants: +NICU criteria: admission to the NICU, anticipated length of stay (LOS) of at least five days, maternal age ≥18 years. -NICU: parents with good general health and age ≥18 years enrolled prior to infant birth. Stool samples: adequate stool processing volume, at least one stool sample from before one month and after one year of age, 7-day minimum between serial samples. Exposures: NICU versus well-baby nursery; antibiotics versus none in first two months of corrected age. Main Outcomes and Measures: Predefined primary outcome- longitudinal CI-ARG abundance by group, compared using linear mixed effects models with adjustment for multiple comparisons (Benjamini-Hochberg procedure). Predefined secondary outcomes- differences in overall microbiota and resistome composition. Results: 1000 serial stool samples, 179 infants (birth-39 months). Longitudinal abundance significantly differed among cohorts for 11 CI-ARG (p<0.05); often higher in the +NICU groups in early life, with or without antibiotic exposure. Abundance of ARG conferring resistance to aminoglycosides, macrolides, and fluoroquinolones later decreased below -NICU levels. Conclusions: This longitudinal study demonstrates significant longitudinal CI-ARG differences in children grouped by early-life NICU status and/or antibiotic exposure. Future studies should explore the mechanisms driving these CI-ARG changes and evaluate their impact on infection risk and community spread.

Identifiers

PMID42856639
PMCPMC13648756

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