Liver Transplantation and Gut Microbiota Profiling in a Child Colonized by a Multi-Drug Resistant Klebsiella pneumoniae: A New Approach to Move from Antibiotic to "Eubiotic" Control of Microbial Resistance

Federica Del Chierico, Sabrina Cardile, Andrea Pietrobattista, Daniela Liccardo, Alessandra Russo, Manila Candusso, Maria Sole Basso, Chiara Grimaldi, Laura Pansani, Paola Bernaschi, Giuliano Torre, Lorenza Putignani

Research output: Contribution to journalArticlepeer-review

Abstract

The increase of microorganisms multi-drug resistant (MDR) to antibiotics (ATBs) is becoming a global emergency, especially in frail subjects. In chronic liver disease (LD) with indications for liver transplantation (LT), MDR colonization can significantly affect the LT outcome. However, no clear guidelines for microbial management are available. A novel approach toward MDR-colonized patients undergoing LT was developed at our Center refraining from ATBs use during the transplant waiting list, and use of an intensive perioperative prophylaxis cycle. This study aimed to couple clinical evaluation with monitoring of gut microbiota in a pediatric LD patient colonized with MDR Klebsiella pneumoniae (KP) who underwent LT. No peri-transplant complications were reported, and a decontamination from the MDR bacteria occurred during follow-up. Significant changes in gut microbiota, especially during ATB treatment, were reported by microbiota profiling. Patterns of Klebsiella predominance and microbiota diversity revealed opposite temporal trends, with Klebsiella ecological microbiota niches linked to ATB-driven selection. Our infection control program appeared to control complications following LT in an MDR-KP-colonized patient. The perioperative ATB regimen, acting as LT prophylaxis, triggered MDR-KP overgrowth and gut dysbiosis, but buffered infectious processes. Mechanisms modulating the gut ecosystem should be taken into account in MDR colonization clinical management.

Original languageEnglish
Number of pages11
JournalInternational Journal of Molecular Sciences
Volume19
Issue number5
DOIs
Publication statusPublished - Apr 25 2018

Keywords

  • Anti-Bacterial Agents/pharmacology
  • Carbapenems/pharmacology
  • Drug Resistance, Bacterial
  • Female
  • Gastrointestinal Microbiome
  • Humans
  • Infant
  • Klebsiella Infections/diagnosis
  • Klebsiella pneumoniae/drug effects
  • Liver Transplantation/adverse effects
  • Postoperative Complications/diagnosis

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