Antibiotic-Associated Hemorrhagic Colitis Caused by Cytotoxin-Producing Klebsiella oxytoca

Abstract

Klebsiella oxytoca was recently described as the causative organism for antibiotic-associated hemorrhagic colitis (AAHC). It is currently not known if this novel gastrointestinal infection exists in children. AAHC is usually preceded by antibiotic treatment with penicillins, which are frequently prescribed for pediatric patients. In contrast to colitis caused by Clostridium difficile, colitis caused by K oxytoca is usually segmental and located predominantly in the right colon. Patients with AAHC typically present with abdominal pain and almost always bloody diarrhea. We present here the case of an adolescent patient who developed acute abdominal pain and bloody diarrhea after antibiotic treatment for acute urinary infection with amoxicillin-clavulanate. Right-sided colitis was verified by abdominal sonography. Stool culture tested negative for common gastrointestinal pathogens but yielded K oxytoca. Toxin production of the isolated strain was verified in a cell-culture assay. Cessation of the causative antibiotic treatment led to rapid improvement and cessation of bloody diarrhea within 3 days. We report here the first (to our knowledge) pediatric case of K oxytoca infection causing AAHC. Establishing the diagnosis of AAHC by culturing K oxytoca and demonstrating right-sided colitis with noninvasive imaging studies might prevent unnecessary invasive procedures in children with bloody diarrhea.

Klebsiella oxytoca: An emerging pathogen?

“…The clinical significance of this is now recognized by its association with nosocomial infections in cohorts of hospitalized patients, including children and neonates. [8][9][10] KPC-producing K. pneumoniae are responsible for higher mortality as compared to non-KPC producers. 11 We observed three isolates of K. pneumoniae that were resistant to colistin and 10 isolates showed resistance to tigecyclin, while none of K. oxytoca showed any resistance to these two antibiotics.…”

Prospective study of bacteremia rate after elective band ligation and sclerotherapy with cyanoacrylate for esophageal varices in patients with advanced liver disease

“…The pathogen was Klebsiella oxytoca, a metallo-beta-lactamase-producing Enterobacteriaceae (1) . This microorganism can cause various infectious complications in both healthy and immunocompromised subjects, such as port central venous catheter-associated bloodstream infection (13) , spontaneous peritonitis (16) and malignant external otitis (6) , and was recently described as the causative agent of antibiotic-associated hemorrhagic colitis (8) . The last condition is usually preceded by antibiotic treatment with penicillin and is more common in childhood.…”

Barbiturate ingestion in three adult captive tigers (Panthera tigris) and concomitant fatal botulism of one : clinical communication

“…Of the bacteria cultured from the necropsy-sampled lung specimen, Klebsiella oxytoca, a Gram-negative rod belonging to the Enterobacteriaceae, is known to cause neonatal septicaemia 16 and haemorrhagic colitis in antibiotic-treated humans 14 , and may have genetic over-expression of Ä-lactamases giving rise to resistance to certain antibiotics; its origin is either environmental such as in water sources 16 , or from the intestinal tract. It has also been reported as an opportunistic pathogen causing severe suppurative otitis media, urogenital tract infections and pneumonia in laboratory rodents, especially those prone to diabetes mellitus or known immune deficiency, as well as in vole moles 2 .…”