The Role of the Gut Microbiome in Antibiotic Resistance and Therapy: Mechanisms and Implications

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: 15 October 2025 | Viewed by 754

Special Issue Editor


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Guest Editor
Institute of Medical Microbiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
Interests: microbiology; antibiotics; microbiome; sequencing; fluoroquinolones; colistin; Klebsiella pneumoniae; animal models
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Special Issue Information

Dear Colleagues,

This Special Issue addresses the complex relationship between the gut microbiome, antibiotic resistance and therapy.

Antibiotics, although essential in the treatment of bacterial infections, can significantly disrupt the gut microbiome, reducing microbial diversity by eliminating beneficial bacteria along with harmful pathogens, allowing opportunistic and resistant strains of bacteria to proliferate. The gut microbiome acts as a reservoir of antibiotic resistance genes, facilitating their horizontal transfer between bacterial species, which contributes to the spread of multidrug-resistant pathogens. In contrast, beneficial commensal bacteria can reduce resistance through mechanisms such as competitive exclusion and colonization resistance, where they outcompete pathogens for resources and produce antimicrobial compounds.

The gut microbiome acts as a reservoir of antibiotic resistance genes, facilitating their horizontal transfer between bacterial species, allowing the spread of multidrug-resistant pathogens. Antibiotic therapy disrupts the gut microbiome by killing not only harmful bacteria but also beneficial microbes, leading to a loss of microbial diversity. This disruption weakens the gut’s natural defenses, allowing opportunistic and antibiotic-resistant bacteria to thrive. Resistant strains can multiply, making infections more difficult to treat.

Recent advances in metagenomics and metabolomics offer personalized antibiotic treatment strategies that minimize collateral damage to beneficial bacteria. Adjunctive therapies such as probiotics and prebiotics hold promise in restoring gut balance and alleviating the side effects of antibiotics. Understanding these mechanisms is key to developing new therapeutic approaches to combat antibiotic resistance and preserve the efficacy of existing antibiotics.

Prof. Dr. Dóra Szabó
Guest Editor

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Keywords

  • gut microbiome
  • antibiotic resistance
  • antibiotic therapy
  • pre- and probiotics
  • horizontal gene transfer
  • ESBL-producing enterobacterales
  • Carbapenem-resistant enterobacterales
  • intestinal colonization
  • clostrioides difficile
  • fecal microbiota transplantation (FMT)

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Published Papers (1 paper)

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Review

17 pages, 422 KB  
Review
Gut Microbiome and Intestinal Colonization with Multidrug-Resistant Strains of Enterobacterales: An Interplay Between Microbial Communities
by Béla Kocsis, Dóra Szabó and László Sipos
Antibiotics 2025, 14(9), 890; https://doi.org/10.3390/antibiotics14090890 - 3 Sep 2025
Viewed by 501
Abstract
Background: The intestinal tract is a host to a high number of diverse bacteria, and the presence of multidrug-resistant (MDR) Enterobacterales strains acts as a reservoir and a source of infection. The interactions between the intestinal microbiome and colonizer Enterobacterales strains influence [...] Read more.
Background: The intestinal tract is a host to a high number of diverse bacteria, and the presence of multidrug-resistant (MDR) Enterobacterales strains acts as a reservoir and a source of infection. The interactions between the intestinal microbiome and colonizer Enterobacterales strains influence long-lasting colonization. Aims: In this narrative review, we summarize available data about the intestinal colonization of MDR Enterobacterales strains and correlations between colonization and the intestinal microbiome. Results: Several endogenous and exogenous factors influence the intestinal colonization of MDR Enterobacterales strains. On the gut microbiome level, the intestinal microbial community is composed of the Lachnospiraceae family (e.g., Lachnoclostridium, Agathobacter, Roseburia, Tyzzerella), which indicates a protective role against colonizer MDR Enterobacterales strains; by contrast, a high abundance of Enterobacterales correlates with the colonization of MDR Enterobacterales strains. In specific patient groups, striking differences in microbiome composition can be detected. Among hematopoietic stem-cell-transplanted patients colonized by extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales, a greater abundance of Bifidobacterium, Blautia, Clostridium, Coprococcus, L-Ruminococcus, Mogibacteriaceae, Peptostreptococceae and Oscillospira was observed compared to patients not colonized by ESBL-producing strains, who had a greater abundance of Actinomycetales. In liver transplant patients, a reduction in the alpha-diversity of the intestinal microbiome in fecal samples correlates with the carriage of MDR Enterobacterales. Conclusions: Intestinal colonization with MDR Enterobacterales is a multifactorial process that involves the MDR strain (e.g., its plasmids, fimbria), host and mucosal factors (e.g., IgA and defensin) and exogenous factors (e.g., use of antibiotics, hospitalization). On the gut microbiome level, the Lachnospiraceae family is dominant among intestines not colonized by MDR strains, but a high abundance of Enterobacterales was correlated with colonization with MDR Enterobacterales strains. Full article
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