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Published on: May 2, 2018
Antibiotic-Associated Apoptotic Enterocolitis in the Absence of a Defined Pathogen: The Role of Intestinal Microbiota
Philipp Wurm1, Walter Spindelboeck, Robert Krause
11Institute of Pathology, Medical University of Graz, Graz, Austria. 2Theodor Escherich Laboratory for Medical Microbiome Research, Medical University of Graz, Graz, Austria. 3Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. 4Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria. 5Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria. 6Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria. 7BioTechMed, Interuniversity Cooperation, Graz, Austria.
Objective:
Antibiotic therapy is a major risk factor for the development of diarrhea and colitis with varying severity. Often the origin of antibiotic-associated gastrointestinal deterioration remains elusive and no specific infectious agents could be discerned.
Patients:
We represent three cases of intractable high-volume diarrhea associated with combined antibiotic and steroid therapy in critically ill patients not fitting into established disease entities. Cases presented with severe apoptotic enterocolitis resembling acute intestinal graft-versus-host-disease. Microbiologic workup precluded known enteropathogens, but microbiota analysis revealed a severely depleted gut microbiota with concomitant opportunistic pathogen overgrowth.
Interventions:
Fecal microbiota transplantation, performed in one patient, was associated with correction of dysbiosis, rapid clinical improvement, and healing of enterocolitis.
Conclusions:
Our series represents a severe form of antibiotic-associated colitis in critically ill patients signified by microbiota depletion, and reestablishment of a physiologic gastrointestinal microbiota might be beneficial for this condition.
Insights
Antibiotic-associated colitis in critically ill patients involves severe gut microbiota depletion. Fecal microbiota transplantation may restore gut health and improve outcomes in these challenging cases.
Area of Science:
- Gastroenterology
- Microbiology
- Critical Care Medicine
Background:
- Antibiotic therapy is a significant risk factor for gastrointestinal issues, including diarrhea and colitis.
- The precise causes of antibiotic-associated gastrointestinal deterioration are often unclear, with no specific infectious agents identified.
Observation:
- Three critically ill patients developed severe, high-volume diarrhea and enterocolitis due to combined antibiotic and steroid therapy.
- The enterocolitis presented as severe apoptotic changes, mimicking acute intestinal graft-versus-host disease.
- Microbiologic analysis revealed depleted gut microbiota with opportunistic pathogen overgrowth, excluding known enteropathogens.
Findings:
- Fecal microbiota transplantation in one patient led to corrected dysbiosis and rapid clinical recovery.
- The transplantation also resulted in the healing of the enterocolitis.
Implications:
- This case series highlights a severe form of antibiotic-associated colitis characterized by profound microbiota depletion in critically ill patients.
- Restoring a physiological gut microbiota through interventions like fecal microbiota transplantation may offer therapeutic benefits for this condition.
