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 language | English |
|---|---|
| Number of pages | 11 |
| Journal | International Journal of Molecular Sciences |
| Volume | 19 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - Apr 25 2018 |
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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
Cite this
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. / Del Chierico, Federica; Cardile, Sabrina; Pietrobattista, Andrea; Liccardo, Daniela; Russo, Alessandra; Candusso, Manila; Basso, Maria Sole; Grimaldi, Chiara; Pansani, Laura; Bernaschi, Paola; Torre, Giuliano; Putignani, Lorenza.
In: International Journal of Molecular Sciences, Vol. 19, No. 5, 25.04.2018.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Liver Transplantation and Gut Microbiota Profiling in a Child Colonized by a Multi-Drug Resistant Klebsiella pneumoniae
T2 - A New Approach to Move from Antibiotic to "Eubiotic" Control of Microbial Resistance
AU - Del Chierico, Federica
AU - Cardile, Sabrina
AU - Pietrobattista, Andrea
AU - Liccardo, Daniela
AU - Russo, Alessandra
AU - Candusso, Manila
AU - Basso, Maria Sole
AU - Grimaldi, Chiara
AU - Pansani, Laura
AU - Bernaschi, Paola
AU - Torre, Giuliano
AU - Putignani, Lorenza
PY - 2018/4/25
Y1 - 2018/4/25
N2 - 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.
AB - 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.
KW - Anti-Bacterial Agents/pharmacology
KW - Carbapenems/pharmacology
KW - Drug Resistance, Bacterial
KW - Female
KW - Gastrointestinal Microbiome
KW - Humans
KW - Infant
KW - Klebsiella Infections/diagnosis
KW - Klebsiella pneumoniae/drug effects
KW - Liver Transplantation/adverse effects
KW - Postoperative Complications/diagnosis
U2 - 10.3390/ijms19051280
DO - 10.3390/ijms19051280
M3 - Article
C2 - 29693574
VL - 19
JO - International Journal of Molecular Sciences
JF - International Journal of Molecular Sciences
SN - 1661-6596
IS - 5
ER -