Enteral Antibiotics Research Articles

Enteral Antibiotics Stimulate Small Intestinal Mucosal Growth in Mice and May Act Synergistically with the Serotonin Signaling System

Background: The intestinal microbiome participates in numerous mucosal processes with previous work demonstrating intestinal mucosal growth in gnotobiotic mice. Others have suggested that certain indigenous gut bacteria are capable of stimulating host serotonin synthesis. Furthermore, potentiation of serotonin signaling has been shown to enhance small intestinal mucosal growth in mice. Thus, we hypothesized that altering the microbiome with enteral antibiotics would enhance small intestinal mucosal growth …

Inpatient Observation After Transition From Intravenous to Oral Antibiotics.

Children hospitalized with infections are commonly transitioned from intravenous (IV) to enteral (per os [PO]) antibiotics before discharge, after which they may be observed in the hospital to ensure tolerance of PO therapy and continued clinical improvement. We sought to describe the frequency and predictors of in-hospital observation after transition from IV to PO antibiotics in children admitted for skin and soft tissue infections (SSTIs). We conducted a retrospective cohort study of children with SSTIs discharged between January 1, 2016, and June 30, 2018, using the Pediatric Health Information System database. Children were classified as observed if hospitalized ≥1 day after transitioning from IV to PO antibiotics. We calculated the proportion of observed patients and used logistic regression with random intercepts to identify predictors of in-hospital observation. Overall, 15% (558 of 3704) of hospitalizations for SSTIs included observation for ≥1 hospital day after the transition from IV to PO antibiotics. The proportion of children observed differed significantly between hospitals (range of 4%-27%; P < .001). Observation after transition to PO antibiotics was less common in older children (adjusted odds ratio [aOR] = 0.69; 95% confidence interval [CI] 0.52-0.90; P = .045). Children initially prescribed vancomycin (aOR = 1.36; 95% CI 1.03-1.79; P = .032) or with infections located on the neck (aOR = 1.72; 95% CI 1.32-2.24; P < .001) were more likely to be observed. Children hospitalized for SSTIs are frequently observed after transitioning from IV to PO antibiotics, and there is substantial variability in the observation rate between hospitals. Specific factors predict in-hospital observation and should be investigated as part of future studies aimed at improving the care of children hospitalized with SSTIs.

Enteral Antibiotics Stimulate Small Intestinal Mucosal Growth in Mice and May Act Synergistically with the Serotonin Signaling System

Enteral Antibiotics Stimulate Small Intestinal Mucosal Growth in Mice and May Act Synergistically with the Serotonin Signaling System

Enteral Antibiotics Act Synergistically with Serotonin to Stimulate Ileal Mucosal Growth in Serotonin Reuptake Transporter Knockout (SERTKO) Mice

Park, Christine J. MD; Shaughnessy, Matthew P. MD; Cowles, Robert A. MD, FACS Author Information

Improving the Transition of Intravenous to Enteral Antibiotics in Pediatric Patients with Pneumonia or Skin and Soft Tissue Infections.

Despite national recommendations for early transition to enteral antimicrobials, practice variability has existed at our hospital. The aim of this study was to increase the proportion of enterally administered antibiotic doses for Pediatric Hospital Medicine patients aged >60 days admitted for uncomplicated community-acquired pneumonia or skin and soft tissue infections from 44% to 75% in eight months. This quality improvement study was conducted at a large, urban, academic children's hospital. The study population included Hospital Medicine patients aged >60 days with diagnoses of pneumonia or skin and soft tissue infections. Interventions included education on intravenous and enteral antibiotic charge differentials, documentation of transition plan, structured discussions of transition criteria, and real-time identification of failures with feedback. Our process measure was the total number of enteral antibiotic doses divided by all antibiotic doses in patients receiving enteral medications on the same day. An annotated statistical process control chart tracked the impact of interventions on the administration route of antibiotic doses over time. Additional outcome measures included antimicrobial costs per patient encounter using average wholesale prices and length of stay. The percentage of enterally administered antibiotic doses increased from 44% to 80% within eight months. Antimicrobial costs per patient encounter and the associated standard deviation of costs for our target diagnoses decreased by 70% and 84%, respectively. Average length of stay did not change. Standardized communication about criteria for transition from intravenous to enteral antibiotics can lead to earlier transitions for patients with pneumonia or skin and soft tissue infections, subsequently reducing costs and prescribing variability.

Macrolides or fluoroquinolones as enteral antibiotic therapy for non-ICU legionellosis

Macrolides or fluoroquinolones as enteral antibiotic therapy for non-ICU legionellosis

Ultra-short bowel syndrome during infancy: improving outcomes and novel therapies.

Ultra-short bowel syndrome is relatively rare and has not yet been extensively reported. In ultra-short bowel syndrome, poor absorption of nutrients and dysmotility, interfere with fluid, energy, electrolyte and micronutrient balance. Patients with this disorder are managed through prolonged parenteral nutrition with the ultimate goal of achieving enteral autonomy. Overall outcomes of these patients are dependent on postsurgical bowel anatomy (residual length, intact colon, ostomy closure timing), incidence of sepsis, and care by a multidisciplinary specialized team. Over the years, standardization of management has improved outcomes. This includes central line care, lipid alternatives, enteral therapy, medications (antidiarrheal agents, acid suppression medications, bile acid binding salts, and enteral antibiotics) including Teduglutide. Bowel lengthening procedures have also proven beneficial, and finally bowel transplant does remain an option for a patient in whom rehabilitation has failed. Although there are many factors that influence outcomes of ultra-short bowel patients, novel therapies such as Teduglutide have been introduced with the aim of improving intestinal adaptation. Surgical lengthening and transplant are viable options in the setting of failed rehabilitation.

Cycled Enteral Antibiotics in Suspected Small Bowel Bacterial Overgrowth Complicating Short Bowel Syndrome - Experience from a Tertiary Neonatal Centre of Canada

Cycled Enteral Antibiotics in Suspected Small Bowel Bacterial Overgrowth Complicating Short Bowel Syndrome - Experience from a Tertiary Neonatal Centre of Canada

Endoscopic naso-leakage drainage: a safe and effective method for the management of intrathoracic anastomotic leakage after esophagectomy.

Intrathoracic anastomotic leakage (IAL) remains a major complication of esophagectomy. Main non-surgical options of management include chest drainage and endoscope interventions. This study is aim to present our experience and assess the efficacy of endoscopic naso-leakage drainage (ENLD) in patients with IAL. From June 2011 to January 2017, 67 patients who developed IAL after esophagectomy and managed by non-surgical approaches were analyzed retrospectively. IAL was confirmed by clinical presentations combined with the evidence of CT scan, radiography and endoscopy. Thirty-eight patients were treated by conventional chest drainage (CD group) and 29 patients underwent ENLD with or without chest drainage (ENLD group), while other treatments including enteral nutrition and antibiotics had no difference between the two groups. In ENLD group, a 12 Fr naso-leakage tube was placed through the leakage to the bottom of vomica under ultra-slim electronic gastroscope. The naso-leakage tube was then connected to a gastrointestinal decompression device for drainage and was also used for rinse. When the vomica diminished and the drainage was also clean, the naso-leakage tube could be pulled back gradually. Finally, healing of the leakage was confirmed endoscopically. Clinical records of the two groups were analyzed. In ENLD group, naso-leakage tubes were successfully placed under endoscope in all 29 patients without any procedure-related complications. In CD group, the mortality is 7.9% (three patients) and five patients (13.2%) developed to systemic inflammatory response syndrome (SIRS) due to insufficient drainage. While in ENLD group, there was only one patient (3.4%) developed to SIRS and no death was observed, but the difference was not statistically significant. When compared with the CD group, the ENLD group had a shorter healing course (44.2±18.3 vs. 60.5±27.7 days, P=0.008), duration of antibiotics usage (16.4±7.8 vs. 11.8±3.8 days, P<0.001) and duration of fever (4.3±2.2 vs. 9.5±8.6 days, P=0.002). To our initial experience, ENLD is an ideal option with safety and efficacy in management of IAL after esophagectomy.

Enteral Antibiotics are Non-inferior to Intravenous Antibiotics After Complicated Appendicitis in Adults: A Retrospective Multicentre Non-inferiority Study.

Prolonging post-operative antibiotic treatment beyond 3days does not seem to reduce the incidence of post-operative abscess formation or wound infection after surgery for complicated appendicitis. The route of administration seems to be based on an empirical basis. Using enteral antibiotics could reduce length of stay and reduce overall costs. We aimed to examine whether treatment with enteral antibiotics during the first three post-operative days is non-inferior to intravenous antibiotics regarding intra-abdominal abscess formation or wound infection after surgery for complicated appendicitis. A retrospective study of adult patients having surgery for complicated appendicitis within a period of 32months in the Capital Region of Denmark. Primary outcome was the incidence of post-operative abscess formation, and secondary outcome was wound infections, both within 30days of surgery. Route of antibiotic administration for the first three post-operative days was registered for all patients. A total of 1141 patients were included in the study. The overall risk of developing an intra-abdominal abscess was 6.7% (95% CI 5.2%; 8.1%), and the risk of wound infection was 1.2% (95% CI 0.6%; 1.8%). In a multivariate intention-to-treat analysis, patients treated post-operatively with enteral antibiotics had an odds ratio of 0.78 (95% CI 0.41; 1.45, p=0.429) for developing an intra-abdominal abscess and an odds ratio of 0.86 (95% CI 0.17; 4.29, p=0.851) for developing a wound infection compared to patients treated post-operatively with intravenous antibiotics. Treatment with enteral antibiotics was non-inferior compared to treatment with intravenous antibiotics during the first 3days after surgery for complicated appendicitis.

腸管内の緑膿菌が増殖を来し非吸収性抗菌薬投与を行った熱傷患者の1例(Enteral administration of non–absorbable antibiotics for abnormal growth of intestinal Pseudomonas aeruginosa developing in a patient with a burn injury)

要旨熱傷など生体への過大な侵襲によって，腸内細菌叢の恒常性が破綻し，腸管内において病原性細菌が増殖することがある。今回我々は，重症熱傷の治療中に，著明な腸管拡張と腸液貯留を伴う腸炎から敗血症となり，便培養検査で緑膿菌の増殖を認めたため，全身性抗菌薬に加え，経腸的に非吸収性抗菌薬を投与し，有効であった症例を経験した。症例は48歳女性，統合失調症で加療されていた。自殺目的で頭から灯油をかぶり，火をつけて受傷し，当院に救急搬送された。気道熱傷と顔面，頸部，前胸部，両上肢に全身の15%の熱傷を認めた。経口気管挿管後に，人工呼吸を含む集中治療管理を行った。経過中に高熱，下痢および著明な腸管拡張を伴う腸炎から敗血症に陥った。Clostridium difficile 感染は否定され，便培養検査で緑膿菌の増殖を認めた。抗菌薬の全身投与に加え，経腸的に非吸収性抗菌薬の投与を行い，投与開始から6日後に便培養で腸管内緑膿菌は陰性化し，それに伴って全身状態も改善した。腸管内の緑膿菌が増殖したことにより，腸炎を起こしたものと考えられた。本症例のように，腸管内において，緑膿菌などの有害な細菌の異常増殖から腸炎となり敗血症の合併が疑われた場合，非吸収性抗菌薬の経腸投与が有効である可能性がある。

Enteral but not parenteral antibiotics enhance gut function and prevent necrotizing enterocolitis in formula-fed newborn preterm pigs.

Preterm infants are susceptible to infection and necrotizing enterocolitis (NEC) and are often treated with antibiotics. Simultaneous administration of enteral and parenteral antibiotics during the first days after preterm birth prevents formula-induced NEC lesions in pigs, but it is unknown which administration route is most effective. We hypothesized that only enteral antibiotics suppress gut bacterial colonization and NEC progression in formula-fed preterm pigs. Caesarean-delivered preterm pigs (90-92% of gestation) were fed increasing amounts of infant formula from birth to day 5 and given saline (CON) or antibiotics (ampicillin, gentamicin, and metronidazole) via the enteral (ENT) or parenteral (PAR) route (n = 16-17). NEC lesions, intestinal morphology, function, microbiology, and inflammatory mediators were evaluated. NEC lesions were completely prevented in ENT pigs, whereas there were high incidences of mild NEC lesions (59-63%) in CON and PAR pigs (P < 0.001). ENT pigs had elevated intestinal weight, villus height/crypt depth ratio, and goblet cell density and reduced gut permeability, mucosal adherence of bacteria, IL-8 levels, colonic lactic acid levels, and density of Gram-positive bacteria, relative to CON pigs (P < 0.05). Values in PAR pigs were intermediate with few affected parameters (reduced lactic acid levels and density and adherence of Gram-positive bacteria, relative to CON pigs, P < 0.05). There was no evidence of increased antimicrobial resistance following the treatments. We conclude that enteral, but not parenteral, administration of antibiotics reduces gut bacterial colonization, inflammation, and NEC lesions in newborn, formula-fed preterm pigs. Delayed colonization may support intestinal structure, function, and immunity in the immediate postnatal period of formula-fed preterm neonates.

Can enteral antibiotics be used to treat pneumonia in the surgical intensive care unit? A clinical outcomes and cost comparison.

Background:Controlling healthcare costs without compromising patient care is a focus given recent healthcare changes in the United States. The purpose of this study was to assess clinical improvement in surgical intensive care unit (SICU) patients initiated on or transitioned to enteral antibiotics compared to those who solely receive intravenous (IV) antibiotic therapy for treatment of bacterial pneumonia.Materials and Methods:This retrospective cohort study included patients with a positive quantitative respiratory culture being treated for bacterial pneumonia in a SICU from 1/1/09 to 3/31/11. Two distinct patient groups were identified: Those treated with IV antibiotics exclusively (IV) and those either initiated on or transitioned to enteral antibiotics within 4 days of antibiotic initiation (PO). The primary endpoint of clinical improvement was assessed on day of antibiotic discontinuation.Results:A total of 647 patients were evaluated; 124 met inclusion criteria (30 patients PO group and 94 IV group). There was no difference in clinical improvement (86.7 PO vs 72.3% IV, P = 0.14) or recurrence (10 PO vs. 12.8% IV, P > 0.99) between groups. Secondary outcomes of duration of mechanical ventilation, ICU and hospital length of stay, and all-cause mortality were also similar. Antibiotic and infection-related costs were significantly decreased in the PO group ($1,042 vs $697, P = 0.04; $20,776 vs $17,381, P = 0.012, respectively).Conclusions:SICU patients initiated on or transitioned to PO antibiotics for pneumonia had similar clinical outcomes, but significantly less infection-related and antibiotic costs compared to those receiving IV therapy. Further, prospective studies are warranted.

Treatment options for acute pancreatitis

This Review covers the latest developments in the treatment of acute pancreatitis. The Atlanta Classification of acute pancreatitis has been revised, proposing several new terms and abandoning some of the old and confusing terminology. The 2012 Revised Atlanta Classification and the determinant-based classification aim to universally define the different local and systemic complications and predict outcome. The most important differences between these classifications are discussed. Several promising treatment options for the early management of acute pancreatitis have been tested, including the use of enteral nutrition and antibiotics as well as novel therapies such as haemofiltration and protease inhibitors. The results are summarized and the quality of evidence is discussed. Finally, new developments in the management of patients with infected pancreatic necrosis are addressed, including the use of the 'step-up approach' and results of minimally invasive necrosectomy.

Gastrointestinal bleeding as a complication of serial transverse enteroplasty

PurposeSerial transverse enteroplasty (STEP) lengthens and tapers bowel in patients with intestinal failure. Evaluation and treatment of serious late gastrointestinal bleeding (GIB) in three STEP patients are described. MethodsPatients participating in an interdisciplinary intestinal rehabilitation program were reviewed to identify those who underwent STEP and had GIB requiring transfusion. ResultsOf 296 patients, 23 underwent STEP, and 3 (13%) had subsequent GIB requiring transfusion. Diagnoses were vanishing gastroschisis/atresia, malrotation/atresia, and gastroschisis.. STEP was performed at ages 3–5months, using 5–15 stapler-firings with an increase in mean bowel length from 39 to 62cm. GIB was diagnosed 5–30months post-op and resulted in 1–7 transfusions per patient. Endoscopy demonstrated staple-line ulceration in two patients and eosinophilic enterocolitis in the third. All were treated with enteral antibiotics, sulfasalazine, and luminal steroids. Those with ulcers responded to bowel rest, and the patient with eosinophilic enterocolitis stabilized with luminal steroids. In all three, hemoglobin levels improved despite persistent occult bleeding. ConclusionsSignificant GIB is a potential late complication of STEP. Endoscopy identified the underlying source of GIB in all three patients. A combination of enteral antibiotics, anti-inflammatory medications, and bowel rest was effective in treating post-STEP GIB, without the need for additional bowel resection.

Intestinal Microbial Diversity and Perioperative Complications

Enteral nutrient deprivation via parenteral nutrition (PN) in a mouse model leads to a local mucosal inflammatory response. This proinflammatory response leads to a loss of epithelial barrier function and atrophy of the intestine. Although the underlying mechanisms are unknown, a potential contributing factor is the impact PN has on the intestinal microbiome. We recently identified a shift in the intestinal microbial community in mice given PN; however, it is unknown whether such changes occur in humans. We hypothesized that similar microbial changes occur in humans during periods of enteral nutrient deprivation. A series of small bowel specimens were obtained from pediatric and adult patients undergoing small intestinal resection. Mucosally associated bacteria were harvested and analyzed using 454 pyrosequencing techniques. Statistical analysis of microbial diversity and differences in microbial characteristics were assessed between enterally fed and enterally deprived portions of the intestine. Occurrence of postoperative infectious and anastomotic complications was also examined. Pyrosequencing demonstrated a wide variability in microbial diversity within all groups. Principal coordinate analysis demonstrated only a partial stratification of microbial communities between fed and enterally deprived groups. Interestingly, a tight correlation was identified in patients who had a low level of enteric microbial diversity and those who developed postoperative enteric-derived infections or intestinal anastomotic disruption. Loss of enteral nutrients and systemic antibiotic therapy in humans is associated with a significant loss of microbial biodiversity within the small bowel mucosa. These changes were associated with a number of enteric-derived intestinal infections and intestinal anastomotic disruptions.

Evaluation of Physicochemical and Microbiological Parameters of Drinking Water Supplied from Distribution Systems of Kathmandu Municipality

Microbial pathogens in drinking water are primary cause in gastrointestinal and waterborne diarrheal diseases. Public health authorities still have not achieved success in controlling the most common waterborne diseases in Nepal. The objective of this study was to assess the quality of drinking water supplied from distribution system of Kathmandu. A total of 114 water samples were collected from 4 distribution stations. The physicochemical and microbiological analyses of water were conducted. Heterotrophic plate count (HPC), detection of enteric pathogenic bacteria and antibiotics susceptibility test were done. Distinct variations in physicochemical parameters were observed. The mean free residual chlorine was found 0.24mg/l. Total Coliforms were found in 61.4% (70/114) of water samples among which 15.7% (11/70) had thermotolerant Coliforms. In distance, coliforms were found higher in far points (p=0.002). All thermotolerant Coliforms were identified as Escherichia coli. Mean HPC of water was found log103.15. The mean HPC of water (p=0.003) was found higher in far point. In collected samples, 10 different enteric bacteria were isolated in which E. coli was found most predominant followed by Pseudomonas spp., Citrobacter spp., Klebsiella spp., Shigella spp., Proteus spp., Enterobacter spp. Non-Typhii Salmonella spp., Providencia spp., Edwardsiella spp. In antibiotics susceptibility test, Gentamicin and Ofloxacin were found most efficient (100%) and whereas Ampicillin (11.5%) was least effective. Multiple antibiotics resistance was found among 5.3% of isolates. Nepal Journal of Science and Technology Vol. 13, No. 2 (2012) 179-184 DOI: http://dx.doi.org/10.3126/njst.v13i2.7733

Enteral nutrition and antibiotic use increase the risk for vitamin K deficiency in patients with severe motor and intellectual disabilities

Summary Background & aims We have investigated the possible risk factors for vitamin K deficiency in subjects with severe motor and intellectual disabilities (SMID). Methods Eighty-two SMID patients were evaluated for their vitamin K intake, serum PIVKA (protein induced by vitamin K absence) -II and ucOC (undercarboxylated osteocalcin) levels; which are vitamin K-dependent hepatic and bone markers, respectively. Results Thirty-six and 19 patients were receiving enteral nutrition (EN) and antibiotics, respectively. Although their serum levels were above the upper reference range in 52% of the subjects for PIVKA-II and 30% of those for ucOC, overt abnormalities in blood coagulation were not observed. Multivariate analyses revealed that EN and antibiotic treatment were significant predictors of the serum PIVKA-II and ucOC levels. Antibiotic treatment affected their serum levels differently in those with EN and those with oral intake (OI). In subjects without antibiotic treatment, vitamin K intake was significantly correlated with circulating levels of PIVKA-II and ucOC, and the breakpoints of vitamin K intake for PIVKA-II and ucOC were 2.5 μg/BW/day and 5.5 μg/BW/day, respectively. Conclusions Vitamin K deficiency was highly prevalent in SMID patients, especially in those receiving both EN and antibiotics. Considering the facts that much more vitamin K is required in the bone than in the liver, and the SMID patients are at high risk of fracture, vitamin K supplementation would be of help in these subjects.

PMO-077 Home enteral tube feeding (HETF): a case burden for the paediatric emergency department (PED)?

IntroductionThe contribution of HETF issues to PED workload is poorly understood. We aimed to evaluate PED attendance records of children receiving HETF (rates, presenting complaints and outcomes). We also aimed...

Protection of Humans by Plant Glucosinolates: Efficiency of Conversion of Glucosinolates to Isothiocyanates by the Gastrointestinal Microflora

Plant-based diets rich in crucifers are effective in preventing cancer and other chronic diseases. Crucifers contain very high concentrations of glucosinolates (GS; β-thioglucoside-N-hydroxysulfates). Although not themselves protective, GS are converted by coexisting myrosinases to bitter isothiocyanates (ITC) which defend plants against predators. Coincidentally, ITC also induce mammalian genes that regulate defenses against oxidative stress, inflammation, and DNA-damaging electrophiles. Consequently, the efficiency of conversion of GS to ITC may be critical in controlling the health-promoting benefits of crucifers. If myrosinase is heat-inactivated by cooking, the gastrointestinal microflora converts GS to ITC, a process abolished by enteric antibiotics and bowel cleansing. When single oral doses of GS were administered as broccoli sprout extracts (BSE) to two dissimilar populations (rural Han Chinese and racially mixed Baltimoreans) patterns of excretions of urinary dithiocarbamates (DTC) were very similar. Individual conversions in both populations varied enormously, from about 1% to more than 40% of dose. In contrast, administration of ITC (largely sulforaphane)-containing BSE resulted in uniformly high (70%-90%) conversions to urinary DTC. Despite the remarkably large range of conversion efficiencies between individuals, repeated determinations within individuals were much more consistent. The rates of urinary excretion (slow or fast) were unrelated to the ultimate magnitudes (low or high) of these conversions. Although no demographic factors affecting conversion efficiency have been identified, there are clearly diurnal variations: conversion of GS to DTC was greater during the day, but conversion of ITC to DTC was more efficient at night.