无明确病原体情况下的抗生素相关性凋亡性小肠结肠炎：肠道微生物群耗竭的作用
Antibiotic-Associated Apoptotic Enterocolitis in the Absence of a Defined Pathogen: The Role of Intestinal Microbiota Depletion.
作者信息
Wurm Philipp, Spindelboeck Walter, Krause Robert, Plank Johannes, Fuchs Gottfried, Bashir Mina, Petritsch Wolfgang, Halwachs Bettina, Langner Cord, Högenauer Christoph, Gorkiewicz Gregor
机构信息
1Institute 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.
出版信息
Crit Care Med. 2017 Jun;45(6):e600-e606. doi: 10.1097/CCM.0000000000002310.
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.
目的
抗生素治疗是腹泻和结肠炎发生的主要危险因素，其严重程度各异。抗生素相关胃肠道恶化的根源往往难以捉摸，无法识别出特定的感染病原体。
患者
我们报告了3例危重症患者中与抗生素和类固醇联合治疗相关的顽固性大量腹泻病例，这些病例不符合既定的疾病实体。病例表现为严重的凋亡性小肠结肠炎，类似于急性肠道移植物抗宿主病。微生物学检查排除了已知的肠道病原体，但微生物群分析显示肠道微生物群严重减少，同时伴有机会性病原体过度生长。
干预措施
1例患者接受了粪便微生物群移植，结果肠道菌群失调得到纠正，临床迅速改善，小肠结肠炎愈合。
结论
我们的系列病例代表了危重症患者中一种严重的抗生素相关性结肠炎，其特征为微生物群减少，重建生理性胃肠道微生物群可能对此病症有益。
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