Zollner-Schwetz Ines, Högenauer Christoph, Joainig Martina, Weberhofer Paul, Gorkiewicz Gregor, Valentin Thomas, Hinterleitner Thomas A, Krause Robert
Section of Infectious Diseases, Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Clin Infect Dis. 2008 Nov 1;47(9):e74-8. doi: 10.1086/592074.
Klebsiella oxytoca was recently shown to be the causative agent of antibiotic-associated hemorrhagic colitis. Because it is unclear whether K. oxytoca also causes nonhemorrhagic antibiotic-associated diarrhea, our study investigated a possible association between K. oxytoca and that disorder.
A total of 371 consecutive patients were recruited into 4 study groups: (1) group A+D+ (patients who received antibiotics and experienced diarrhea; n = 107), (2) group A+D- (patients who received antibiotics but did not experience diarrhea; np93), (3) group A-D+ (patients who experienced acute-onset diarrhea but did not receive antibiotics; n = 60), and (4) group A-D- (patients without diarrhea who did not receive antibiotics; n = 111). Stool samples were plated on MacConkey agar and K. oxytoca was identified using a standard test kit. Clostridium difficile was detected by a toxin A/B antigen test. K. oxytoca strains were tested for cytotoxicity with use of cell-culture assays.
In 15 of 371 stool samples, K. oxytoca strains were isolated during the study period. There was no significant difference in the distribution of K. oxytoca among the 4 study groups. Six of the 15 strains were found to be toxin producing. Three of the toxin-producing strains caused antibiotic-associated hemorrhagic colitis. No case of nonhemorrhagic antibiotic-associated diarrhea due to toxin-producing K. oxytoca was detected.
K. oxytoca is not the causative agent of nonhemorrhagic antibiotic-associated diarrhea. This is in contrast to the distinct clinical entity of antibiotic-associated hemorrhagic colitis. Testing for K. oxytoca is therefore only warranted for patients who experience bloody diarrhea during antibiotic therapy.
最近研究表明产酸克雷伯菌是抗生素相关性出血性结肠炎的病原体。由于目前尚不清楚产酸克雷伯菌是否也会引发非出血性抗生素相关性腹泻，我们的研究对产酸克雷伯菌与该疾病之间可能存在的关联进行了调查。
总共371例连续患者被纳入4个研究组：（1）A+D+组（接受抗生素治疗且出现腹泻的患者；n = 107），（2）A+D-组（接受抗生素治疗但未出现腹泻的患者；n = 93），（3）A-D+组（出现急性腹泻但未接受抗生素治疗的患者；n = 60），以及（4）A-D-组（未接受抗生素治疗且未出现腹泻的患者；n = 111）。粪便样本接种于麦康凯琼脂平板，使用标准检测试剂盒鉴定产酸克雷伯菌。通过毒素A/B抗原检测法检测艰难梭菌。利用细胞培养试验检测产酸克雷伯菌菌株的细胞毒性。
在研究期间，从371份粪便样本中的15份分离出产酸克雷伯菌菌株。4个研究组中产酸克雷伯菌的分布无显著差异。15株菌株中有6株被发现可产生毒素。其中3株产毒素菌株导致了抗生素相关性出血性结肠炎。未检测到由产毒素产酸克雷伯菌引起的非出血性抗生素相关性腹泻病例。
产酸克雷伯菌不是非出血性抗生素相关性腹泻的病原体。这与抗生素相关性出血性结肠炎这一独特的临床实体形成对比。因此，仅对抗生素治疗期间出现血性腹泻的患者进行产酸克雷伯菌检测才有必要。
