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Role of Klebsiella oxytoca in Antibiotic-Associated Diarrhea.
Clin Infect Dis. 2008 Sep 22;
Authors: Zollner-Schwetz I, Högenauer C, Joainig M, Weberhofer P, Gorkiewicz G, Valentin T, Hinterleitner TA, Krause R
Background. @nbsp; Klebsiella oxytoca was recently shown to be the causative agent of antibiotic-associated hemorrhagic colitis. Because it is unclear whether K. oxytoca also causes nonhemorrhagic antibiotic-associated diarrhea, our study investigated a possible association between K. oxytoca and that disorder. Methods. @nbsp; A total of 371 consecutive patients were recruited into 4 study groups: (1) group A(+)D(+) (patients who received antibiotics and experienced diarrhea; [Formula: see text]), (2) group A(+)D(-) (patients who received antibiotics but did not experience diarrhea; [Formula: see text]), (3) group A(-)D(+) (patients who experienced acute-onset diarrhea but did not receive antibiotics; [Formula: see text]), and (4) group A(-)D(-) (patients without diarrhea who did not receive antibiotics; [Formula: see text]). Stool samples were plated on MacConkey agar and K. oxytoca was identified using a standard test kit. Clostridium difficile was detected by a toxin A/B antigen test. K. oxytoca strains were tested for cytotoxicity with use of cell-culture assays. Results. @nbsp; In 15 of 371 stool samples, K. oxytoca strains were isolated during the study period. There was no significant difference in the distribution of K. oxytoca among the 4 study groups. Six of the 15 strains were found to be toxin producing. Three of the toxin-producing strains caused antibiotic-associated hemorrhagic colitis. No case of nonhemorrhagic antibiotic-associated diarrhea due to toxin-producing K. oxytoca was detected. Conclusion. @nbsp; K. oxytoca is not the causative agent of nonhemorrhagic antibiotic-associated diarrhea. This is in contrast to the distinct clinical entity of antibiotic-associated hemorrhagic colitis. Testing for K. oxytoca is therefore only warranted for patients who experience bloody diarrhea during antibiotic therapy.
PMID: 18808355 [PubMed - as supplied by publisher]