{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:09:09Z","timestamp":1792548549910,"version":"4.5.0"},"reference-count":209,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T00:00:00Z","timestamp":1741132800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Cheng Hsin General Hospital"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>With nearly half of colorectal cancer (CRC) patients diagnosed at advanced stages where surgery alone is insufficient, chemotherapy remains a cornerstone for this cancer treatment. To prevent infections and improve outcomes, antibiotics are often co-administered. However, chemotherapeutic interactions with the gut microbiota cause significant non-selective toxicity, affecting not only tumor and normal epithelial cells but also the gut microbiota. This toxicity triggers the bacterial SOS response and loss of microbial diversity, leading to bacterial mutations and dysbiosis. Consequently, pathogenic overgrowth and systemic infections increase, necessitating broad-spectrum antibiotics intervention. This review underscores how prolonged antibiotic use during chemotherapy, combined with chemotherapy-induced bacterial mutations, creates selective pressures that drive de novo antimicrobial resistance (AMR), allowing resistant bacteria to dominate the gut. This compromises the treatment efficacy and elevates the mortality risk. Restoring gut microbial diversity may mitigate chemotherapy-induced toxicity and improve therapeutic outcomes, and emerging strategies, such as fecal microbiota transplantation (FMT), probiotics, and prebiotics, show considerable promise. Given the global threat posed by antibiotic resistance to cancer treatment, prioritizing antimicrobial stewardship is essential for optimizing antibiotic use and preventing resistance in CRC patients undergoing chemotherapy. Future research should aim to minimize chemotherapy\u2019s impact on the gut microbiota and develop targeted interventions to restore microbial diversity affected during chemotherapy.<\/jats:p>","DOI":"10.3390\/antibiotics14030264","type":"journal-article","created":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T05:54:38Z","timestamp":1741154078000},"page":"264","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Exploring the Impact of Chemotherapy on the Emergence of Antibiotic Resistance in the Gut Microbiota of Colorectal Cancer Patients"],"prefix":"10.3390","volume":"14","author":[{"given":"Mutebi John","family":"Kenneth","sequence":"first","affiliation":[{"name":"Department of Earth and Environmental Sciences, National Chung Cheng University, Chiayi 621, Taiwan"},{"name":"Doctoral Program in Science, Technology, Environment and Mathematics, National Chung Cheng University, Chiayi 621, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chin-Chia","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Colorectal Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622, Taiwan"},{"name":"College of Medicine, Tzu Chi University, Hualien 970, Taiwan"},{"name":"School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuan-Yin","family":"Fang","sequence":"additional","affiliation":[{"name":"Division of Colon and Rectal Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsui-Kang","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Cheng Hsin General Hospital, Taipei 112, Taiwan"},{"name":"School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1418-4977","authenticated-orcid":false,"given":"I-Ching","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Asia University Hospital, Taichung 413, Taiwan"},{"name":"Department of Kinesiology, Health and Leisure, Chienkuo Technology University, Changhua 500, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2410-5320","authenticated-orcid":false,"given":"Shih-Wei","family":"Huang","sequence":"additional","affiliation":[{"name":"Center for Environmental Toxin and Emerging Contaminant Research, Cheng Shiu University, Kaohsiung 833, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Chou","family":"Chiu","sequence":"additional","affiliation":[{"name":"General Surgery, Surgical Department, Cheng Hsin General Hospital, Taipei 112, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2988-8408","authenticated-orcid":false,"given":"Bing-Mu","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Earth and Environmental Sciences, National Chung Cheng University, Chiayi 621, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1038\/s41575-019-0189-8","article-title":"Global burden of colorectal cancer: Emerging trends, risk factors and prevention strategies","volume":"16","author":"Keum","year":"2019","journal-title":"Nat. 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