Antibiotic-Associated Apoptotic Enterocolitis in the Absence of a Defined Pathogen: The Role of Intestinal Microbiota Depletion.

Abstract:

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.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Wurm P,Spindelboeck W,Krause R,Plank J,Fuchs G,Bashir M,Petritsch W,Halwachs B,Langner C,Högenauer C,Gorkiewicz G

doi

10.1097/CCM.0000000000002310

subject

Has Abstract

pub_date

2017-06-01 00:00:00

pages

e600-e606

issue

6

eissn

0090-3493

issn

1530-0293

journal_volume

45

pub_type

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