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2017 ; 45
(6
): e600-e606
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Antibiotic-Associated Apoptotic Enterocolitis in the Absence of a Defined
Pathogen: The Role of Intestinal Microbiota Depletion
#MMPMID28333760
Wurm P
; Spindelboeck W
; Krause R
; Plank J
; Fuchs G
; Bashir M
; Petritsch W
; Halwachs B
; Langner C
; Högenauer C
; Gorkiewicz G
Crit Care Med
2017[Jun]; 45
(6
): e600-e606
PMID28333760
show ga
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.