Department of Biomedical Research, Maurice Müller Laboratories, University Clinic of Visceral Surgery and Medicine, Inselspital and.
University Children's Hospital, Inselspital, University of Bern, Bern, Switzerland.
Pediatrics. 2018 Sep;142(3). doi: 10.1542/peds.2018-0337. Epub 2018 Aug 8.
Intestinal microbiota composition in children with short bowel syndrome (SBS) is an important factor influencing the clinical outcome. An increase of D-lactate-producing bacteria can lead to D-lactic acidosis, also referred to as D-lactate encephalopathy, with severe neurologic impairment. Antibiotic treatments for D-lactic acidosis in children with SBS offer often only short-term relief. Here, we present the case of a boy with SBS who developed recurrent episodes of D-lactic acidosis even under continuous cycling antibiotic treatment. Microbiological analyses were used to detect the presence of D-lactate-producing species in the stool samples. A probiotic cocktail was introduced to alter the intestinal microbiota. During follow-up under treatment with probiotics, the patient remained stable, and there was no additional need for antibiotic therapy for more than a year. Stool composition of the patient was sequenced regularly over that period. His microbiota profile changed completely in species richness, and a clustering of species according to probiotic usage was seen. Importantly, D-lactate-producing strains disappeared within a few weeks after probiotic introduction and were no longer detected in the subsequent follow-up specimens.
儿童短肠综合征（SBS）患者的肠道微生物组成是影响临床结局的重要因素。产 D-乳酸的细菌增加可导致 D-乳酸酸中毒，也称为 D-乳酸脑病，伴有严重的神经功能损伤。SBS 患儿的 D-乳酸酸中毒的抗生素治疗往往只能提供短期缓解。在这里，我们介绍了一例 SBS 患儿的病例，即使在连续循环抗生素治疗下，该患儿仍反复发生 D-乳酸酸中毒。微生物分析用于检测粪便样本中产 D-乳酸的细菌种类。引入益生菌混合物来改变肠道微生物群。在接受益生菌治疗的随访期间，患者保持稳定，并且在超过一年的时间内无需进行抗生素治疗。在此期间，患者的粪便成分定期进行测序。他的微生物群谱在物种丰富度上发生了完全变化，并且根据益生菌使用情况出现了物种聚类。重要的是，益生菌引入后数周内产 D-乳酸的菌株消失，并且在随后的随访标本中不再检测到。
