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 22 January 2018

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News

K oxytoca causes antibiotic-associated hemorrhagic colitis

Klebsiella oxytoca causes antibiotic-associated hemorrhagic colitis, reports the latest issue of the New England Journal of Medicine.

News image

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Antibiotic-associated hemorrhagic colitis is a distinct form of antibiotic-associated colitis in which Clostridium difficile is absent.

Although the cause is not known, previous reports have suggested a role of Klebsiella oxytoca.

Dr Christoph Högenauer and colleagues studied 22 consecutive patients who had suspected antibiotic-associated colitis but negative for C difficile.

Patients underwent diagnostic colonoscopy.

Among those who received a diagnosis of antibiotic-associated hemorrhagic colitis, stool samples were cultured for K oxytoca.

The research team isolated K oxytoca strains and tested them for cytotoxin production using a tissue-culture assay.

K oxytoca was found in about 2% of the healthy subjects
New England Journal of Medicine

In addition, the researchers cultured stool samples obtained from 385 healthy subjects for K oxytoca.

An in vivo animal model for antibiotic-associated hemorrhagic colitis was established with the use of Sprague-Dawley rats.

Of the 22 patients, the team identified 6 with findings on colonoscopy that were consistent with the diagnosis of antibiotic-associated hemorrhagic colitis.

The researchers noted that 5 of these 6 patients had positive cultures for K oxytoca.

The research team found no other common enteric pathogens in the 5 patients.

Before the onset of colitis, all 5 were receiving penicillins, and 2 were also taking nonsteroidal antiinflammatory drugs (NSAIDs).

The researchers observed that all isolated K oxytoca strains produced cytotoxin.

The team found K oxytoca in about 2% of the healthy subjects.

In the animal model, K oxytoca was found only in the colon of rats receiving amoxicillin-clavulanate in addition to K oxytoca inocculation.

In these rats, infection with K oxytoca induced a right-sided hemorrhagic colitis.

The researchers did not observe this in uninfected animals that received amoxicillin-clavulanate, indomethacin, or both.

Dr Högenauer's team concludes, “Our fulfillment of Koch's postulates for cytotoxin-producing K oxytoca suggests that it is the causative organism in at least some cases of antibiotic-associated hemorrhagic colitis.”

“Infection with K oxytoca should be considered in patients with antibiotic-associated colitis who are negative for C difficile.”

NEJM 2006: 355(23): 2418-26
11 December 2006

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