Liver Transplantation and Gut Microbiota Profiling in a Child Colonized by a Multi-Drug Resistant Klebsiella pneumoniae: A New Approach to Move from Antibiotic to “Eubiotic” Control of Microbial Resistance

Abstract

The increase of microorganisms multi-drug resistant (MDR) to antibiotics (ATBs) is becoming a global emergency, especially in frail subjects. In chronic liver disease (LD) with indications for liver transplantation (LT), MDR colonization can significantly affect the LT outcome. However, no clear guidelines for microbial management are available. A novel approach toward MDR-colonized patients undergoing LT was developed at our Center refraining from ATBs use during the transplant waiting list, and use of an intensive perioperative prophylaxis cycle. This study aimed to couple clinical evaluation with monitoring of gut microbiota in a pediatric LD patient colonized with MDR Klebsiella pneumoniae (KP) who underwent LT. No peri-transplant complications were reported, and a decontamination from the MDR bacteria occurred during follow-up. Significant changes in gut microbiota, especially during ATB treatment, were reported by microbiota profiling. Patterns of Klebsiella predominance and microbiota diversity revealed opposite temporal trends, with Klebsiella ecological microbiota niches linked to ATB-driven selection. Our infection control program appeared to control complications following LT in an MDR-KP-colonized patient. The perioperative ATB regimen, acting as LT prophylaxis, triggered MDR-KP overgrowth and gut dysbiosis, but buffered infectious processes. Mechanisms modulating the gut ecosystem should be taken into account in MDR colonization clinical management.

Impact of Co-Delivery of EGCG and Tuna Oil within a Broccoli Matrix on Human Gut Microbiota, Phenolic Metabolites and Short Chain Fatty Acids In Vitro

“…This could help polyphenols enter into enterohepatic circulation and result in a longer presence of polyphenols in the body, preventing diseases related to oxidative stress [ 38 ]. Klebsiella is often related to gut microbiome dysbiosis and can be multi-drug (antibiotic) resistant [ 39 ]. It also plays a role in polyphenol metabolism, indicating that the metabolism route for EGCG or Klebsiella is more resistant to EGCG [ 39 ].…”

Impact of Two Antibiotic Therapies on Clinical Outcome and Gut Microbiota Profile in Liver Transplant Paediatric Candidates Colonized by Carbapenem-Resistant Klebsiella pneumoniae CR-KP

“…In our previous study, performed in a single case study, we proposed microbiota profiling in the clinical management of these transplant patients. Our evidence opened a new point of view that may guide clinicians on the choice of the appropriate antibiotic strategies and monitor the MDR colonization and microbiota eubiotic reversion after MDR colonization and ATB treatment insults ( Del Chierico et al., 2018 ). The identification of high-risk patients by microbial signatures may allow for tailored interventions and an improvement in LT outcomes ( Annavajhala et al., 2019 ).…”

“…In comparison, the survival rate of the overall LT patients during the same time was higher than 88% ( Adam et al., 2018 ; Kwong et al., 2020 ). The majority of these studies focused on adult LT recipients ( Hand and Patel, 2016 ; Ferrarese et al., 2018 ) while in a paediatric population they are starting to appear ( Del Chierico et al., 2018 ; Sun et al., 2021 ).…”

Potential of multiomics technology in precision medicine

“…The classic concept of infection associated with a single organism that invades our body and reproduces itself by inducing a series of alterations is no longer acceptable. In fact, it has been discovered that some diseases appear to be caused by imbalances of microorganisms’ populations rather than by a single pathogen [15 ▪ ]. This new model can be extended to various diseases and not only be confined to infectious processes.…”