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

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 gui...

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Published in:International journal of molecular sciences 2018-05, Vol.19 (5), p.1280
Main Authors: 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
Format: Article
Language:English
Subjects:
Antibiotics
carbapenem resistant-Klebsiella pneumoniae
Case Report
Colonization
Decontamination
Drug resistance
Dysbacteriosis
gut microbiota
Intestinal microflora
Klebsiella
Klebsiella pneumoniae
Liver
Liver diseases
liver transplantion
Liver transplants
Microbiota
Microorganisms
microorganisms multi-drug resistant
Multidrug resistance
Niches
Patients
pediatrics
Prophylaxis
Transplantation
Transplants & implants
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Summary: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 (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 predominance and microbiota diversity revealed opposite temporal trends, with 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.
ISSN:1422-0067
1661-6596
1422-0067
DOI:10.3390/ijms19051280