Faecal Flora Of Patients Research Articles

Characteristic of Extended Spectrum β-Lactamase-Producing Enterobacteriaceae from Fecal Carriage Isolates of Intensive Care Unit Patients at Sanglah Hospital, Bali, Indonesia

Background: The increasing Extended-Spectrum β-Lactamases-producing Enterobacteriaceae (ESBL-PE) infections in the Intensive Care Unit (ICU) needs an early warning system for the detection of these bacteria. The ESBL-PE fecal carriage analysis is a screening method that can be used to detect and characterize these bacteria. Furthermore, it aids in assessing an ICU patient’s risk of possible infection and prevent its transmission to the other patients within the period of hospitalization; therefore, enhancing the quality of patient care while alsoreducing morbidity and mortality due to ESBL-PE infection in ICU. Objective: The study aimed to determine the antibiogram and molecular characteristics of ESBL-PE fecal carriage from ICU patients at Sanglah Hospital, Denpasar, Bali. Methods: This cross-sectional retrospective study involved 30 stored-bacterial isolates of ESBL-PE from a rectal swab of ICU patients who had just been admitted to the ICU of Sanglah General Hospital from February to March 2019, consecutively. The identification and antimicrobial susceptibility test of the isolates were conducted using Vitek-2 Compact (bioMérieux®, Marcy-l'Etoile, France), while genotype identification was conducted using PCR for the detection of blaTEM, blaSHV, blaCTX-M genes. Results: Thirty bacterial isolates were identified as Escherichia coli (24/30) and Klebsiella spp. (6/30) and detected as ESBL-producing isolates by Vitek-2 Compact. All isolates were susceptible to piperacillin-tazobactam, meropenem, and amikacin. Twenty-two (73.3%) isolates harbored ESBLs blaTEM, blaSHV, blaCTX-M genes, either individually or in combination. Most of the isolates had the combination of ESBL genes. About 20% (6/30) of isolates had a combination of blaTEM and blaCTX-M, while 10% (3/30) of them possessed all of the three genes detected in this study. Only 3.3% (1/30) of the isolates had each combination of blaTEM and blaSHV as well as blaSHV and blaCTX-M. Meanwhile, 16.7% (5/30) of the isolates were detected to have each single gene of blaCTX-M or blaTEM, and only one isolate (3.3%) harbored blaSHV. Conclusion: High prevalence of blaTEM, blaSHV, and blaCTX-M ESBL genes harbored by fecal flora of patients who had just been admitted in ICU give rise to the risk for transmission among critically ill patients in ICU. Fecal screening of ESBL-PE besides infection control can be considered for those patients who have a risk factor of ESBL-PE colonization before they are being admitted to the ICU.

Bystander Selection for Antimicrobial Resistance: Implications for Patient Health.

Antimicrobial therapy promotes resistance emergence in target infections and in off-target microbiota. Off-target resistance emergence threatens patient health when off-target populations are a source of future infections, as they are for many important drug-resistant pathogens. However, the health risks of antimicrobial exposure in off-target populations remain largely unquantified, making rational antibiotic stewardship challenging. Here, we discuss the contribution of bystander antimicrobial exposure to the resistance crisis, the implications for antimicrobial stewardship, and some novel opportunities to limit resistance evolution while treating target pathogens.

Differences between the gut microflora of children with autistic spectrum disorders and that of healthy children

Children with autistic spectrum disorders (ASDs) tend to suffer from severe gastrointestinal problems. Such symptoms may be due to a disruption of the indigenous gut flora promoting the overgrowth of potentially pathogenic micro-organisms. The faecal flora of patients with ASDs was studied and compared with those of two control groups (healthy siblings and unrelated healthy children). Faecal bacterial populations were assessed through the use of a culture-independent technique, fluorescence in situ hybridization, using oligonucleotide probes targeting predominant components of the gut flora. The faecal flora of ASD patients contained a higher incidence of the Clostridium histolyticum group (Clostridium clusters I and II) of bacteria than that of healthy children. However, the non-autistic sibling group had an intermediate level of the C. histolyticum group, which was not significantly different from either of the other subject groups. Members of the C. histolyticum group are recognized toxin-producers and may contribute towards gut dysfunction, with their metabolic products also exerting systemic effects. Strategies to reduce clostridial population levels harboured by ASD patients or to improve their gut microflora profile through dietary modulation may help to alleviate gut disorders common in such patients.

Biodiversity in the fecal flora of patients with active and inactive IBD: Molecular assessment with temporal temperature gradient gel electrophoresis

Biodiversity in the fecal flora of patients with active and inactive IBD: Molecular assessment with temporal temperature gradient gel electrophoresis

Biodiversity in the fecal flora of patients with active and inactive IBD: Molecular assessment with temporal temperature gradient gel electrophoresis

Biodiversity in the fecal flora of patients with active and inactive IBD: Molecular assessment with temporal temperature gradient gel electrophoresis

Molecular analysis of the fecal flora of patients with inactive colonic crohn's disease

Molecular analysis of the fecal flora of patients with inactive colonic crohn's disease

Molecular analysis of the fecal flora of patients with inactive colonic crohn's disease

Molecular analysis of the fecal flora of patients with inactive colonic crohn's disease

Effect of antibiotic therapy on the antibiotic resistance of faecal Escherichia coli in patients attending general practitioners.

To analyse the influence of antibiotic therapy on the faecal flora of patients from general practice with complaints of a respiratory tract infection (RTI), 189 paired faecal specimens were collected, before and after completing antibiotic treatment (n = 129) and symptomatic treatment (n = 60). Faecal specimens were examined for the prevalence and degree of resistance to amoxycillin, apramycin, ciprofloxacin, nalidixic acid, neomycin, nitrofurantoin, oxytetracycline, sulphamethoxazole and trimethoprim. In the antibiotic-treated group a significant increase in the prevalence of resistance to amoxycillin post-treatment from 50% to 64% (P < 0.05, Wilcoxon) was observed. In the symptomatic treated group no significant differences in the prevalence of resistance were found. Using discriminant analysis, amoxycillin and doxycycline therapy contributed to an increased prevalence of resistance to amoxycillin and oxytetracycline, respectively. In the antibiotic-treated group Escherichia coli isolates post-treatment had a significantly increased resistance rate to amoxycillin (15%-23%) and to neomycin (2%-6%) (P < 0.05, Wilcoxon). Logistic regression analysis showed a cross resistance to neomycin and kanamycin, and for kanamycin cross-resistance to apramycin, neomycin and streptomycin occurred.

Effects on an Elemental Diet on the Faecal Flora in Patients with Crohn's Disease

Alteration of faecal microbial flora has been suggested as a possible mechanism by which elemental diets exert their therapeutic effects in Crohn’s disease. Thirteen patients with active Crohn’s disease (mean CDAI 284 ± 34) were studied. Faecal samples were collected before and at weekly intervals after starting the elemental diet Vivonex for a period of 4 wk. The composition of the faecal microbial flora was assessed using a semi-quantitative method which has been calibrated against an established quantitative surface viable count technique. The only significant change in the faecal flora observed during the period of dietary treatment was a marked reduction in the scores of anaerobic lactobacilli ( P ≤ 0.0001); these organisms disappeared from the stools of eight (62 per cent) patients. However, the change in lactobacilli scores was not related to changes in the clinical condition as assessed by the CDAI and established laboratory indicators of activity. The results of this study show that alteration of the faecal flora does not explain the therapeutic value of elemental diets in Crohn’s disease. Keywords: Crohn’s disease; Elemental diet; Faecal flora; Vivonex.

The assessment of faecal flora in patients with inflammatory bowel disease by a simplified bacteriological technique

A semi-quantitative bacteriological method was used to study faecal flora in 42 patients with Crohn's disease, 37 with ulcerative colitis and 21 healthy controls. Faecal homogenates were plated on primary isolation plates by a technique that allowed the growth of various microbial isolates to be assessed on a visual 1(+)-5+ score. This method was first calibrated against a standard quantitative bacteriological technique, which confirmed the reliability and reproducibility of the results obtained by the simpler method. Patients with clinically active Crohn's disease (22) had significantly higher total aerobe scores than patients with quiescent disease (20) (p less than or equal to 0.006) or ulcerative colitis (p less than or equal to 0.04) or normal controls (p less than or equal to 0.02). The scores of Escherichia coli were parallel to those of total aerobes. Lactobacillus and bifidobacteria scores were significantly reduced in patients with Crohn's disease compared to those with ulcerative colitis and controls. The anaerobic flora in both Crohn's disease and ulcerative colitis was indistinguishable from that of controls. Bacteroides vulgatus and B. fragilis were the predominant bacteroides in all groups. Patients with ulcerative colitis, regardless of disease activity, harboured faecal flora that did not differ from that of normal controls. The abnormal faecal flora in Crohn's disease did not correlate with established clinical and laboratory indicators of disease activity.

Effects on an Elemental Diet on the Faecal Flora in Patients with Crohn's Disease

Effects on an Elemental Diet on the Faecal Flora in Patients with Crohn's Disease

Effect of ceftazidime and gentamicin on the oropharyngeal and faecal flora of patients with haematological malignancies

Thirty-four patients with haematological malignancies were studied to investigate the effect of empirical broad-spectrum antibiotic therapy (ceftazidime and gentamicin) on the gastro-intestinal flora. Twenty-five patients with acute myeloid leukaemia or post-autologous bone-marrow transplantation were given framycetin, nystatin and colistin (Fracon), and two patients with non-Hodgkin's Lymphoma were on co-trimoxazole, as long-term gut prophylaxis. Semi-quantitative microbiology was carried out on oropharyngeal swabs and quantitative microbiology on faecal specimens. The oropharyngeal flora consisted mainly of streptococci, coagulase-negative staphylococci and coryneforms, and was little affected by ceftazidime/gentamicin. A strain of Enterobacter cloacae resistant to ceftazidime and gentamicin colonized one patient, who later developed septicaemia. The faecal flora of patients on Fracon was dominated by enterococci; the few enterobacteria present were eliminated by ceftazidime/gentamicin. The anaerobic flora was absent in 15% of patients; in the remainder, it consisted mainly of Bacteroides spp., and was little affected by ceftazidime/gentamicin. The faecal flora of patients not on Fracon always contained anaerobes, and some strains of enterobacteria persisted throughout antibiotic treatment. None of the patients was colonized by Clostridium difficile or Pseudomonas aeruginosa. Broad-spectrum therapy with ceftazidime and gentamicin appeared to have little effect on the gastro-intestinal flora, except to encourage the overgrowth of enterococci and reduce the numbers of enterobacteria.

Induction of chronic arthritis in rats by cell wall fragments of anaerobic coccoid rods isolated from the faecal flora of patients with Crohn's disease.

Crohn's disease and ulcerative colitis are accompanied by seronegative arthritis in about one fifth of the cases. In the present study, cell wall fragments from major residents such as Eubacterium, Coprococcus and Peptostreptococcus species, isolated from the faecal flora of patients with Crohn's disease, were tested for properties to induce chronic arthritis in Lewis rats. Cell wall fragments from Eubacterium contortum strains Me44 and Me47 were found to induce chronic arthritis; Peptostreptococcus productus strain C 18 cell wall fragments induced acute self-limiting arthritis. Coprococcus comes strain Me46 cell walls, on the other hand, were found to be lethal to the majority of rats inoculated, whereas those which survived did not develop acute or chronic arthritis. The results indicate that intraperitoneal injection of a single dose of cell wall fragments from bacteria that are major residents of the human anaerobic faecal flora can induce chronic inflammatory joint disease in the rat.

Increased proteolysis and leucine aminopeptidase activity in faeces of patients with Crohn's disease.

Proteolytic and leucine aminopeptidase activity levels in faeces from patients with Crohn's disease and healthy subjects were compared and were found to be 2.5 and 6 times higher, respectively, in patients with Crohn's disease. Patients who had undergone partial bowel resection even showed a 12- and 40-fold increase of enzyme activities. A part of the elevated levels of faecal proteases probably results from ileal malabsorption. This was supported by studies in germ-free and conventional rats showing that the ileum is the major site of absorption of digestive proteolytic enzymes and leucine aminopeptidase. The other part of the increased protease activity was attributed to the abnormal anaerobic faecal flora of patients with Crohn's disease. Interactions between flora and enzymes were studied in rats. The resident flora of the caecum was found to stimulate absorption, or to inactivate the major part of the remaining enzymes. The elevated levels of faecal proteases in Crohn's disease may play a role in the damage of the intestinal mucosa.

Increased Faecal Glycosidases in Patients with Crohn’s Disease

The strictly anaerobic faecal flora of patients with Crohn's disease (CD) contains higher numbers of coccoid rods (Eubacterium, Peptostreptococcus and Coprococcus species) and gram-negative rods (Bacteroides vulgatus) than the flora of healthy subjects. The abnormal flora of patients with CD might affect levels of glycolytic enzymes and metabolic products and thus play some role in the pathogenesis of CD. Therefore, the activity of 23 glycosidases that can degrade mucus glycoproteins or plant polysaccharides, in faeces of patients with CD was compared with healthy subjects. Total enzyme activity in faecal samples of patients with CD was significantly higher than in healthy subjects, but statistically the activity of individual enzymes did not significantly differ. Faecal glycosidase activity is predominantly of bacterial origin since glycosidase activity was absent or very low in faeces of germ-free rats.

Long-Term Antibiotic Therapy for Acne Vulgaris: Effects on the Bowel Flora of Patients and Their Relatives

We have studied the effects of long-term tetracycline and erythromycin administration on the fecal flora of patients and their relatives. Tetracycline administration selects for multiply antibiotic-resistant organisms in both patients and relatives. Erythromycin exerts no such selection pressure. The mechanisms by which this may occur are discussed.

Binding of Coprococcus comes to the Fc portion of IgG. A possible role in the pathogenesis of Crohn's disease?

Previous studies have shown that the fecal flora of patients with Crohn's disease (CD) differed from the flora of healthy subjects by a higher number of anaerobic gram-positive coccoid rods. Sera from patients with CD agglutinated four strains of coccoid rods (Me44, C18, Me46 and Me47) more frequently and stronger than sera from healthy subjects and patients with other diseases. One of these bacteria, Coprococcus comes strain Me46, was not ingested by neutrophils after coating with specific IgG. In the present study, therefore, the binding of IgG and of Fab and Fc fragments to the four coccoid rods was investigated using immunofluorescence and absorption techniques. Results were compared with those obtained with Staphylococcus aureus strain Cowan I and showed that Me46, like S. aureus, bound (nonspecifically) IgG through its Fc portion whereas strain Me47 bound IgG through the Fab portion. Possible implications of the findings for CD are discussed.

A possible role of Eubacterium and Peptostreptococcus species in the aetiology of Crohn's disease.

The faecal flora of patients with Crohn's disease has been found to contain higher numbers of anaerobic gram-negative rods and gram-positive coccoid rods than the flora of healthy subjects. In a considerable percentage of sera from patients with Crohn's disease, agglutinating antibodies were found against four strains of the coccoid rods, in contrast to sera from patients with ulcerative colitis, other diseases and healthy subjects. In the present study, coccoid strains C18, Me46 and Me47 were found to activate complement by the alternative pathway. IgG antibodies to strains Me44, C18 and Me47 had opsonic properties but those to strain Me46 failed to induce phagocytosis. The data suggest an inadequate immune defence against strain Me46 in patients with Crohn's disease. The possible role of strain Me46 in the pathogenesis of Crohn's disease is discussed.

Changes in the Fecal Flora of Patients with Crohn's Disease During Treatment with Metronidazole

Six patients with Crohn's disease and three healthy volunteers were treated with metronidazole. Before and during metronidazole treatment quantitative and qualitative studies of the aerobic and anaerobic fecal bacterial flora were performed, and the minimal inhibitory concentration (MIC) values for metronidazole of the isolated bacteria were determined. There was no significant change in the fecal flora of the volunteers during metronidazole treatment, but three patients who clinically responded well to treatment had drastically changed their anaerobic flora. Two patients did not respond to the metronidazole therapy. The total anaerobic count for one of them was unchanged, and the number of isolated anaerobic species was high during the treatment. The total anaerobic counts of the other non-responder decreased, but metronidazole-resistant (MIC greater than or equal to 40 microgram/ml) Gram-negative rods remained in the fecal samples. Furthermore, after 2 months his condition worsened, and he was given corticosteroids and parenteral nutrition. The result in one patient with a moderate response to therapy was intermediate. Our observations may explain why some patients benefit from metronidazole therapy and others do not.

Proceedings: The faecal flora of patients with Crohn's disease.

Proceedings: The faecal flora of patients with Crohn's disease.