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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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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5983657/
https://www.ncbi.nlm.nih.gov/pubmed/29693574
http://dx.doi.org/10.3390/ijms19051280
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author 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
author_facet 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
author_sort Del Chierico, Federica
collection PubMed
description 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.
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spelling pubmed-59836572018-06-05 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 Int J Mol Sci Case Report 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. MDPI 2018-04-25 /pmc/articles/PMC5983657/ /pubmed/29693574 http://dx.doi.org/10.3390/ijms19051280 Text en © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
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
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
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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5983657/
https://www.ncbi.nlm.nih.gov/pubmed/29693574
http://dx.doi.org/10.3390/ijms19051280
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