Probiotics Show Promise in Reducing Antibiotic Resistance in Vulnerable Preterm Infants
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New research indicates that targeted probiotic supplementation-specifically strains of Bifidobacterium and Lactobacillus-could significantly improve gut โขhealth โฃand combat the rise of antibioticโข resistance in very-low-birth-weight (VLBW) preterm infants. โคTheseโ infants, often requiring prolonged stays inโฃ neonatal intensive care units (NICUs), are particularly susceptible to disruptions in early โขmicrobial colonization and the subsequent โฃexpansionโ of antibiotic-resistant genes (ARGs).
The findings, published in Nature Communications, offer โขa strategic approach toโข antimicrobial stewardship and newborn care, potentially lessening the burden of multidrug-resistant (MDR) organisms in a highly vulnerable population.
Studyโข details โฃand Keyโ Findings
Researchers enrolled 34 VLBWโค infantsโข exclusively fed human โขmilk. The study compared infants receiving a probiotic supplement (PS) containing Bifidobacterium bifidum and Lactobacillus acidophilus to a control groupโฃ that did not (NPS). Using shotgun โmetagenomic sequencing, the team analyzed the โคinfants’ gut โฃmicrobiome โand resistome during โคthe first three weeks of life.They also โconducted plasmid-transfer experiments in โa neonatal gutโ model to assess โขthe potential for horizontal gene transfer (HGT).
The PS group exhibited fewer ARGs and โฃreduced growth of common pathobionts, including Enterococcus, Escherichia, and Klebsiella, compared to the NPS group. Beneficialโ Bifidobacterium species,โ such as B. breve and B. longum subsp. infantis, were more prevalent in theโ probiotic-supplemented infants. Furthermore, Escherichia and Klebsiella strains in the PS group were less likely to display โMDR traits observed in the NPS group.
Interestingly, brief, standardized antibiotic use did โnot significantly alterโ overall microbiome diversity in eitherโ group. This suggests that the โobserved changes wereโ primarily driven by โthe probioticโ supplementation, rather than antibiotic exposure.
Did You Know? The โhuman gut microbiome contains trillions of microorganisms,playing a criticalโ role in health,immunity,and evenโฃ brain function. Disruptions to this delicate โecosystem, especially in early life, can have lasting consequences.
Horizontal โขGene Transfer and Probiotic Limitations
Mechanisticโ studies revealed both the promise andโค limitations of this approach.In an ex vivo infantโฃ gut model, a 137-kb megaplasmid carrying the aminoglycoside resistance gene aac6-aph2 transferred between Enterococcus strains, conferring gentamicin resistance even in a Bifidobacterium-rich environment. This highlights that while probiotics can reduce ARG burden and impede MDR colonization, HGT remains a possibility within early-life microbial communities.
Clinical Implications and Guidelines
Theseโฃ findings align with expertโ recommendations supporting probiotic use in selectโฃ pretermโค infant populations to reduce the โคrisk of necrotizing enterocolitis (NEC) and mortality. Though, emphasis is placed on the importance of high-quality, safe products and strain specificity. The โEuropean โฃSociety for Paediatric Gastroenterology, Hepatologyโ and Nutrition (ESPGHAN) recommends using rigorously manufactured products with documented โstrains and viable counts, alongside โฃstandardized NICU protocols for product selection, storage, and โขadministration 1.
| Factor | Probiotic Supplement (PS)โ Group | No โProbiotic โคSupplement (NPS) Group |
|---|---|---|
| Antibiotic Resistance Genes (ARGs) | fewer | More |
| Pathobiont Growth | Reduced (Enterococcus, โฃEscherichia, Klebsiella) | Increased |
| Bifidobacterium Species | Higher prevalence (B. breve, B. longum subsp. infantis) | Lower prevalence |
| MDR Traits โin Escherichia/Klebsiella | Less frequent | More โขfrequent |
Pharmacist’s Viewpoint
NICU โฃpharmacists can play a pivotal role in implementing probiotic strategiesโ asโ a core component of antimicrobial stewardship. This includes rigorous product vetting-assessing strain type, colony-forming unitโฃ (CFU) content, excipients, and manufacturing quality-as well as establishing โprotocols for storage, handling, and timing to maximize benefits and minimize antimicrobial inactivation. Collaboration with neonatology and infection prevention teams is crucial for integrating probioticsโ into broaderโข stewardship โpathways aimed at suppressing โคARG emergence and MDR colonization.
Pro Tip: Pharmacists should educate clinicians and familiesโ about the realistic expectations of probiotic supplementation. While probiotics can reduce ARG prevalenceโ andโ control growth, they cannot entirely eliminate the riskโฃ of plasmid-mediated resistance spread. Success depends on using the correct strains, dosages, and โฃprotocols.
What are the biggest challenges to widespread probiotic adoption in NICUs, and โhow can these be overcome? โ โขhow can long-term monitoring of gut โmicrobiome compositionโข inform probiotic strategiesโ for preterm infants?
Conclusion
Early โคprobiotic supplementation in VLBW preterm infants resulted in fewerโฃ ARGs, โขreduced MDRโ from key โขpathobionts, and increased levels of beneficial Bifidobacterium during a critical periodโ of advancement. While HGT remains a concern,these results support โฃa well-defined โprobiotic plan-led by pharmacists-as an integral part of NICU care and antimicrobial control. Further research and long-term follow-up are needed to clarify durability, safety, and clinical outcomes 2.
REFERENCES
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Probiotics for pretermโ babies lowered antibiotic resistant bacteria in gut, new studyโค shows. EurekAlert! Published August 15, โ2025. Accessed โAugust 19, 2025. https://www.eurekalert.org/news-releases/1094868
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Kiu, R.,โ Darby, E.M., Alcon-Giner,โข C. et al. impact of early life antibiotic and โคprobiotic treatment on gut microbiome and resistome of very-low-birth-weight preterm infants. Nat Commun 16, 7569 (2025).https://doi.org/10.1038/s41467-025-62584-2
The increasing prevalence of antibiotic resistance is a global health crisis,driving the need for innovative strategies to preserve โantibiotic effectiveness. โข Microbiome-directed therapies, such as probiotic supplementation, represent a promising โavenue โคfor addressing this challenge,โ particularly in vulnerable populations like preterm infants.Ongoing โขresearch is focused โคon identifyingโข optimal โขprobiotic strains, โdosages, and โdelivery methods to maximize benefits and minimize risks. โ The long-term impact of early-life microbiome modulationโฃ on immune developmentโค and overall health remains an โคactive area of investigation.
Frequently Asked Questions About Probiotics and Preterm Infants
- What are probiotics, and how do they work? Probiotics areโ live microorganisms โthat, when administered in adequate amounts,โค confer a health benefit on the host. They work byโ modulating โthe โgut microbiome,competing with harmful bacteria,and enhancing โขimmune function.
- Are all probiotics the same? no. different probiotic strains have different effects. Theโ choice of strain is crucial for achieving specific health outcomes.
- What is the role of the gut microbiome in preterm infants? The gut microbiome plays aโ vital role โคin โnutrient absorption,immune system development,and protection against pathogens.Preterm infants have an underdeveloped microbiome, โขmaking them more susceptible to infections and complications.
- Can probiotics prevent necrotizing enterocolitisโค (NEC)? โ Probiotic supplementation has โคbeen shown to reduceโ the risk of NEC, a serious intestinal disease, in some preterm infants.
- Are there any risks associated with probiotic use โin preterm infants? โคwhile generally safe, probiotics can cause mild side effects like gas or bloating. in rare cases, more serious complications โฃhave been reported, particularlyโข in very sick infants.
We hope this article provided valuable insights into the potentialโ ofโ probiotics in improving the health of vulnerable preterm infants. โค Please share this information โwith โฃyour network, leave a comment below with your thoughts, or subscribe โขto our newsletter forโข more updates onโ cutting-edge medical research.
