Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Ulbl, F.
Antibiotic-associated diarrhoea and Klebsiella oxytoca
[ Diplomarbeit ] Medical University of Graz; 2008. pp. 79
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Hoegenauer Christoph
- Lippe Irmgard Theresia
- Altmetrics:
- Abstract:
- Antibiotic-associated diarrhoea (AAD) is a common side effect of treatment with antibiotic agents. Around 10 to 20% of cases are caused by pathogenic bacterial overgrowth. Antibiotic-associated hemorrhagic colitis (AAHC) first described in 1978 was recently found to be caused by Klebsiella oxytoca. Not much is know yet about the underlying pathophysiological mechanisms. But since other forms of toxin-induced colitis resemble findings of AAHC it has been suggested that the disease is cytotoxin mediated. We have made efforts to gather information on demographic and clinical characteristics from patients with AAHC. Data from 20 cases diagnosed at the Medical University of Graz were collected and retrospectively analysed. To confirm the diagnosis, made on the basis of clinical history patients underwent diagnostic colonoscopy. Stools were examined and tested negative for bacteria commonly causing AAD. Consistent with typical findings on endoscopy and the absence of C. difficile infection, the disease was classified as antibiotic-associated haemorrhagic colitis. Klebsiella strains from stool samples were cultured with the use of MacConkey agar plates and isolated. In order to substantiate the hypothesis that pathogenic Klebsiella strains produce toxins responsible for the cytotoxic effects seen in AAHC further microbiological and biochemical analyses - as the API 20E test for identifying colonies and the MTT test for assessment of cytotoxic activity as well as a PCR were subsequently conducted. The assumption that findings in AAHC were toxin induced could be confirmed with further evidence. Typically, patients suffering AAHC are young and otherwise healthy. Although K. oxytoca does not represent a frequent cause of diarrhoea incidence was higher than for some other common enteric pathogens. Since symptoms resolve spontaneously after cessation of antibiotics the disease might be underdiagnosed and the actual prevalence therefore is suspected to be higher outside the hospital setting. Clostridium difficile-associated diarrhoea (CDAD) is an own entity of antibioticassociated diarrhoea. With an estimated incidence of 110 per 100.000 admissions CDAD is the most common nosocomial infection in many European hospitals. It is exceeding diseases due to methicillin-resistant Staphylococcus aureus (MRSA) and can involve a mortality rate of 20%. The disease therefore is of increasing relevance for health care institutions. With regard to the major impact of C. difficile on public health questions it has received special attention in the work at hand. Current literature