In patients with advanced liver cirrhosis, antibiotic use is linked to changes in the gut microbiome, including fewer types of bacteria, a rise in Enterococcus bacteria, and increased Candida fungi.
Mechanism
Synthesis from 1 study
Antibiotics wipe out helpful gut bacteria, letting harmful ones like Enterococcus and yeast like Candida take over. Without the good bacteria to keep the gut lining strong, things leak into the bloodstream and trigger constant inflammation, making liver disease worse.
Most probable mechanism
Antibiotics kill off many of the good bacteria in the gut, especially those that produce nutrients the gut lining needs to stay intact. Without these good bacteria, harmful bacteria like Enterococcus take over because they can survive the antibiotics and don't need the same nutrients. At the same time, the loss of good bacteria removes natural checks on yeast, allowing Candida to grow unchecked. The damaged gut lining lets bacteria and yeast components leak into the bloodstream, triggering widespread inflammation that worsens liver disease.
Broad-spectrum antibiotics reduce the total number and diversity of gut bacteria, selectively sparing or promoting the growth of antibiotic-resistant species such as Enterococcus while depleting commensal bacteria that produce short-chain fatty acids.
Depletion of short-chain fatty acid-producing bacteria reduces the energy supply to intestinal epithelial cells, weakening the tight junctions between them and increasing intestinal permeability.
Loss of bacterial competition and suppression of antifungal metabolites allows Candida species to proliferate and dominate the fungal community in the gut.
Increased intestinal permeability enables translocation of bacterial components (e.g., lipopolysaccharides, peptidoglycans) and fungal cell wall components (e.g., β-glucans) into the portal circulation.
Translocated microbial components activate immune receptors on liver and systemic immune cells, triggering sustained release of pro-inflammatory cytokines and markers of macrophage activation.
Chronic inflammation and immune activation impair liver function and increase susceptibility to secondary infections, including fungal infections.
Evidence from Studies
Supporting (1)
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