Spectrum and antibiotic sensitivity of bacteria contaminating the upper gut in patients with malabsorption syndrome from the tropics

BMC Gastroenterology

Archana Ayyagari¹  Subhash R Naik²  Piyush Ranjan²  Uday C Ghoshal²  Ujjala Ghoshal¹ 

[1] Department of Microbiology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow 226014, India;Department of Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow 226014, India

关键词: tropical sprue;    antibiogram;    India;    gut flora;    jejunal aspirate culture;    Small bowel bacterial overgrowth;   

Others  :  1215893
DOI  :  10.1186/1471-230X-3-9

 received in 2003-01-15, accepted in 2003-05-24,  发布年份 2003

【 摘 要 】

Background

Various causes of malabsorption syndrome (MAS) are associated with intestinal stasis that may cause small intestinal bacterial overgrowth (SIBO). Frequency, nature and antibiotic sensitivity of SIBO in patients with MAS are not well understood.

Methods

Jejunal aspirates of 50 consecutive patients with MAS were cultured for bacteria and colony counts and antibiotic sensitivity were performed. Twelve patients with irritable bowel syndrome were studied as controls.

Results

Culture revealed growth of bacteria in 34/50 (68%) patients with MAS and 3/12 controls (p < 0.05). Colony counts ranged from 3 × 10² to 10¹⁵ (median 10⁵) in MAS and 100 to 1000 (median 700) CFU/ml in controls (p 0.003). 21/50 (42%) patients had counts ≥10⁵ CFU/ml in MAS and none of controls (p < 0.05). Aerobes were isolated in 34/34 and anaerobe in 1/34. Commonest Gram positive and negative bacteria were Streptococcus species and Escherichia coli respectively. The isolated bacteria were more often sensitive to quinolones than to tetracycline (ciprofloxacin: 39/47 and norfloxacin: 34/47 vs. tetracycline 19/47, <0.01), ampicillin, erythromycin and co-trimoxazole (21/44, 14/22 and 24/47 respectively vs. tetracycline, p = ns).

Conclusions

SIBO is common in patients with MAS due to various causes and quinolones may be the preferred treatment. This needs to be proved further by a randomized controlled trial.

【 授权许可】

   
2003 Ghoshal et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Toskes PP: Bacterial overgrowth of the gastrointestinal tract. Adv Int Med 1993, 38:387-407.
• [2]Simon GL, Gorbach SL: The human intestinal microflora. Dig Dis Sci 1986, 31:147-62.
• [3]Justensen T, Haagen Nielsen O, Jacobson E, et al.: The normal cultivable microflora in upper jejunal fluid in healthy adults. Scand J Gastroneterol 1984, 19:279-82.
• [4]Ballen LS, Russel RM: Bacterial overgrowth syndrome. Clinical Perspectives in Gastroenterology 2000, 225-31.
• [5]Chiarioni G, Bassotti G, Germani U, et al.: Gluten-free diet normalizes mouth-to-cecum transit of a caloric meal in adult patients with celiac disease. Dig Dis Sci 1997, 42:2100-5.
• [6]Ghoshal UC, Ghoshal U, Ayyagari A, Ranjan P, Krishnani N, Misra A, Aggarwal R, Naik S, Naik SR: Tropical sprue is associated with contamination of small bowel with aerobic bacteria and reversible prolongation of orocaecal transit time. J Gastroenterol Hepatol 2003, 18:540-7.
• [7]Dwinell MB, Bass P, Schaefer DM, Oaks JA: Tapeworm infection decreases intestinal transit and enteric aerobic bacterial population. Am J Physiol 1997, 273:G480-5.
• [8]Eisenberg RL: Gastrointestinal radiology: A pattern approach. Philadelphia: JB Lippincott Company 1990, 441-51.
• [9]Bouhnik Y, Alain S, Attar A, Flourie B, Raskine L, Sanson-Le Pors MJ, Rambaud JC: Bacterial populations contaminating upper gut in patients with small intestinal bacterial overgrowth syndrome. Am J Gastroenterol 1999, 94:1327-31.
• [10]Isaacs PET, Kim YS: The contaminated small bowel syndrome. Am J Med 1979, 67:1049-56.
• [11]Tabacquali S: The pathophysiological role of small intestinal bacterial flora. Scand J Gastroenterol 1970, 5:139-63.
• [12]Raffensperger EC, D'Agostino F, Manfredo H, Ramirez M, Brooks FP, O'Neill F: Fecal fat excretion: an analysis of four years' experience. Arch Intern Med 1967, 119:573-6.
• [13]Ghoshal UC, Ghoshal U, Kumar A, Jain A, Aggarwal R, Misra A, Ayyagari A, Naik SR: Strongyloides stercoralis infestation associated with septicemia due to intestinal transmural migration of bacteria. J Gastroenterol Heptol 2002, 17:1331-3.
• [14]Ranjan P, Ghoshal UC, Ghoshal U, Aggarwal R, Ayyagari A, Naik S, Naik SR: A prospective study of etiological spectrum of malabsorption syndrome in North India. Indian J Gastroenterol 2001, 20(Suppl 2):A19.
• [15]Drossman DA, Camilleri M, Mayer EA, Whitehead WE: AGA technical review on irritable bowel syndrome. Gastroenterology 2002, 123:2108-31.
• [16]Collee JG, Miles RS, Walt B: Tests for the identification of bacteria. In Mackie and McCartney Practical Medical Microbiology. Edited by Collee JG, Fraser AG, Marmion BP, Simmons A. New York: Churchill Livingstone; 1996:131-49.
• [17]Anonymous: Processing clinical specimens for anaerobic bacteria: Isolation and identification procedures. In Bailey and Scott's Diagnostic Microbiology. Edited by Baron EJ, Peterson LR, Finegold SM. Philadelphia: Mosby; 1994:474-503.
• [18]Ananthanarayan R, Panikar CKJ: Textbook of microbiology. Chennai: Orient Longman 1999, 244-9.
• [19]Levitt MD: Oxygen tension in the gut. N Engl J Med 1970, 282:1039-40.
• [20]Abdulkarim AS, Burgart LJ, See J, Murray JA: Etiology of nonresponsive celiac disease: Results of a systemic approach. Am J Gastroenterol 2002, 97:2016-21.
• [21]Nussinson E, Lahav M, Berebi A, Estrov Z, Zur S, Resnitzky P: Secretory piece and IgA deficiency in a patient with Waldenstrom's macroglobulinemia. Am J Gastroenterol 1986, 81:995-8.
• [22]Pereira SP, Khin-Maung U, Bolin TD, Duncombe VM, Nyunt-Nyunt-Wai , Myo-Khin , Linklater JM: A pattern of breath hydrogen excretion suggesting small bowel bacterial overgrowth in Burmese village children. J Pediatr Gastroenterol Nutr 1991, 13:32-38.
• [23]Khin-Maung U, Bolin TD, Pereira SP, Duncombe VM, Myo-Khin , Nyunt-Nyunt-Wai , Linklater JM: Epidemiology of small bowel bacterial overgrowth and rice malabsorption in Burmese (Myanmar) village children. Am J Trop Med Hyg 1992, 47:298-304.
• [24]Archar GL, Polk KE: Approach to therapy for bacterial diseases. In Harrison's Principles of Internal Medicine. Edited by Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson LR. McGraw-Hill, Inc; 2001:867-82.
• [25]King CE, Toskes PP: Small intestinal bacterial overgrowth. Gastroenterology 1979, 76:1035-55.
• [26]Attar A, Flourie B, Rambaud JC, Franchisseur C, Ruszniewski P, Bouhnik Y: Antibiotic efficacy in small intestinal bacterial overgrowth-related diarrhoea: a crossover, randomized trial. Gastroenterology 1999, 117:794-7.