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 journalArticle

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

Fingerprint

Klebsiella
pneumonia
transplantation
antibiotics
Klebsiella pneumoniae
Antibiotics
liver
Liver
Liver Transplantation
drugs
Anti-Bacterial Agents
Pharmaceutical Preparations
Microbiota
prophylaxis
Transplants
Liver Diseases
Dysbiosis
decontamination
Pediatrics
Waiting Lists

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

@article{3b192cb4ab2f41bda9d3ccac1395981a,
title = "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",
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.",
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",
author = "{Del Chierico}, Federica and Sabrina Cardile and Andrea Pietrobattista and Daniela Liccardo and Alessandra Russo and Manila Candusso and Basso, {Maria Sole} and Chiara Grimaldi and Laura Pansani and Paola Bernaschi and Giuliano Torre and Lorenza Putignani",
year = "2018",
month = "4",
day = "25",
doi = "10.3390/ijms19051280",
language = "English",
volume = "19",
journal = "International Journal of Molecular Sciences",
issn = "1661-6596",
publisher = "MDPI AG",
number = "5",

}

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 -