An Investigation On Association Of Antibiotic Exposure With Mild Cognitive Impairment Among The Elderly In Lu'an City

ObjectiveTo describe the situation of antibiotic exposure in the elderly in Lu'an City,and analyze the prevalence and influencing factors of mild cognitive impairment?MCI?in the elderly,and explore the association between antibiotic exposure and MCI.MethodsFrom June to September 2016,a multi-stage stratified random sampling method was used to select two communities in Lu'an City.People aged 60 years and above who have lived for more than 6 months are included in the Elderly Health and Environment Risk Factor Cohort?EHERF?.We surveyed 1080 people,and a total of990 elderly people were finally able to be included in the study.The self-made questionnaire of"the Elderly Health and Environment Controllable Factors"was used to collect the socio-demographic data of the elderly,and the MCI status was screened by the Mini-mental State Examination?MMSE?.Collected morning urine and detected45 antibiotic prototypes and 2 metabolites by liquid chromatography-tandem mass spectrometry?LC-MS/MS?in the urine samples.The rates of antibiotic exposure were expressed as a percentage?%?,specific percentiles(P₉₅,P₉₉)and the maximum values were used to describe concentration of antibiotics.The effect of region,age,gender,and dietary habits on antibiotic exposure levels was analyzed using the Chi-square test.The association between urine antibiotic creatinine adjusted concentrations and MCI was analyzed using logistic regression.ResultsThe bio-monitoring results showed that 34 antibiotics were detected,with a total detection frequency of 93.0%and detection rates ranging from 0.2%to 35.5%.In the MCI people,11 antibiotics have a detection frequency of more than 10%,including sulfachloropyrazine,ofloxacin,flufenicol,trimethoprim,tetracycline,oxytetracycline,doxycycline,azithromycin,penicillin V,ciprofloxacin and norfloxacin.The detection rates of Veterinary antibiotics?VAs?and Preferred as veterinary antibiotics?PVAs?were 64.9%and 71.4%,respectively.The total antibiotic concentration of 64.2%of the elderly was between LODs and 20.0 ng/m L,but there were 6 PVAs at a maximum concentration of more than 5000 ng/m L.The detection rate of antibiotics in the elderly was significantly different in different regions,age,sex and dietary habits groups.The detection frequencies of sulfamethoxazole,sulfachloropyrazine,oxytetracycline,ofloxacin,ciprofloxacin and fluorooquinolones?FQs?were higher in rural elderly than in urban elderly.The detection rates of trimethoprim,azithromycin,macrolides?MAs?and human antibiotics?HAs?were higher in urban areas,and the differences were statistically significant?P<0.05?.The detection rates of sulfamethoxazole,sulfadiazine,tetracycline,and enrofloxacin were higher among the elderly>70 years,and the detection rates of sulfamethoxazole and chlortetracycline were higher in 60-70 years group.The detection rates of trimethoprim,tetracycline,Sulfonamides?SAs?,and PVAs were higher in the men elderly than in the women,whereas sulfamethazine were lower than in the women,and the difference was statistically significant?P<0.05?.There were also statistically significant differences in the detection rates of trimethoprim,tetracycline,sarafloxacin,chloramphenicol?PCs?,and HAs in elderly people with different dietary habits?P<0.05?.This study found that the number of elderly people with MCI was 185,with a prevalence of 18.7%.Univariate logistic analysis showed that gender,age,region,education,marital status,previous occupation,whether living alone,exercise,eating habits,BMI,depression,and the chronic diseases were the influencing factors of MCI?P<0.05?.Analysis of the association between antibiotic exposure and MCI showed that:there are statistical correlations between urinary creatinine concentration of florfenicol?OR=1.81,95%CI:1.06?3.09?,tetracycline?OR=0.36,95%CI:0.14?0.92?,TCs?OR=0.58,95%CI:0.33?0.97?,PCs?OR=1.86,95%CI:1.11?3.11?,PHAs?OR=0.53,95%CI:0.28?0.99?and MCI?P<0.05?.After adjusting relevant variables such as gender,age,region,marital status,education level,etc.,florfenicol,tetracycline,TCs and PHAs still statistically correlated with MCI?P<0.05?.After stratification by sex,after adjusting for confounding variables,in men,the association between MAs?OR=2.27,95%CI:1.03?5.04?,HAs?OR=2.48,95%CI:1.11?5.55?,PVAs?OR=3.39,95%CI:1.42?8.10?and MCI was statistically significant?P<0.05?.There was a statistically significant correlation between the low PCs concentration group?OR=2.32,95%CI:1.09?4.91?and MCI in women?P<0.05?.The results of age stratification analysis found that the elderly>70 years old with a low exposure to PVAs?OR=1.94,95%CI:1.04 to 3.64?had a higher risk for MCI.ConclusionThe elderly in Lu'an were extensively exposed to antibiotic,such as sulfachloropyrazine,trimethoprim,ofloxacin,oxytetracycline,and tetracycline.This study found that exposure to low concentrations of flufenicol and PCs in the elderly may increase the risk of MCI.There are sex-and age-specific difference in the association between antibiotic exposure levels and MCI:low concentrations of PVAs may increase the elderly>70 years and the men's risk of MCI and low concentrations of PCs may increase the risk of MCI in women.