4.7 Article

Antibiotic Treatments During Infancy, Changes in Nasal Microbiota, and Asthma Development: Population-based Cohort Study

Journal

CLINICAL INFECTIOUS DISEASES
Volume 72, Issue 9, Pages 1546-1554

Publisher

OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciaa262

Keywords

airway microbiota; antibiotics; asthma; causal mediation; children

Funding

  1. University of Turku
  2. Abo Akademi University
  3. Turku University Hospital
  4. Academy of Finland [123571, 140251, 277535, 324926]
  5. Emil Aaltonen Foundation
  6. Finnish Medical Foundation
  7. Paivikki and Sakari Sohlberg Foundation
  8. Foundation for Pediatric Research
  9. Allergy Research Foundation
  10. Paulo Foundation
  11. Research Funds from Specified Government Transfers, Hospital District of Southwest Finland
  12. Tampere Tuberculosis Foundation
  13. Orion Research Foundation
  14. Juho Vainio Foundation
  15. Foundation of the Finnish AntiTuberculosis Association
  16. Academy of Finland (AKA) [324926, 324926] Funding Source: Academy of Finland (AKA)

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Early exposures to antibiotics were associated with increased risk of asthma; the effect was partly mediated by longitudinal changes in the nasal airway microbiota.
Background. Early-life exposures to antibiotics may increase the risk of developing childhood asthma. However, little is known about the mechanisms linking antibiotic exposures to asthma. We hypothesized that changes in the nasal airway microbiota serve as a causal mediator in the antibiotics-asthma link. Methods. In a population-based birth-cohort study in Finland, we identified longitudinal nasal microbiota profiles during age 2-24 months using 16S rRNA gene sequencing and an unsupervised machine learning approach. We performed a causal mediation analysis to estimate the natural direct effect of systemic antibiotic treatments during age 0-11 months on risks of developing physician-diagnosed asthma by age 7 years and the natural indirect (causal mediation) effect through longitudinal changes in nasal microbiota. Results. In our birth cohort of 697 children, 8.0% later developed asthma. Exposure to >= 2 antibiotic treatments during age 0-11 months was associated with a 4.0% increase in the absolute risk of developing asthma (absolute increase, 95% CI, .9-7.2%; P = .006). The unsupervised clustering approach identified 6 longitudinal nasal microbiota profiles. Infants with a larger number of antibiotic treatments had a higher risk of having a profile with early Moraxella sparsity (per each antibiotic treatment, adjusted RRR, 1.38; 95% CI, 1.15-1.66; P < .001). This effect of antibiotics on asthma was partly mediated by longitudinal changes in the nasal microbiota (natural indirect effect, P = .008), accounting for 16% of the total effect. Conclusions. Early exposures to antibiotics were associated with increased risk of asthma; the effect was mediated, in part, by longitudinal changes in the nasal airway microbiota.

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