Introduction: Recently, Klebsiella oxytoca was found to be the causative for antibioticassociated hemorrhagic colitis (AAHC). Whether K. oxytoca plays a role in non-hemorrhagic antibiotic-associated diarrhea (AAD) is unknown. The aim of our study was therefore to investigate whether this bacterium is associated with AAD.
Methods: 371 patients were recruited into 4 study groups: (1) group AAD (patients receiving antibiotics and experiencing diarrhea, n=107), (2) group A+D- (patients receiving antibiotics but not experiencing diarrhea, n=93), (3) group A-D+ (patients experiencing acute onset diarrhea but not receiving antibiotics, n=60), (4) group A-D- (control patients, n=111). Stool samples were plated on MacConkey agar and K. oxytoca was identified by API 20E. C. difficile was detected by toxin A/B antigen test. K. oxytoca strains were tested for cytotoxicity using a cell-culture assay.
Results: There was no significant difference in distribution of K. oxytoca in the 4 groups. 3 cases of AAHC were recorded. A total of 15 K. oxytoca strains were isolated during the study period in all patient groups. Five of these strains were found to be toxin – producing.
|
|
AAD
|
A+D-
|
A-D-
|
A-D+
|
|
Number of patients
|
104
|
93
|
111
|
60
|
|
Positive for
|
1/104
|
1/93
|
5/111
|
5/60
|
|
K. oxytoca
|
(0,9%)
|
(1,1%)
|
(4,5%)
|
(8,3%)
|
|
Positive for
|
12/104
|
0/93
|
0/111
|
2/60
|
|
C. difficile toxin
|
(11,5%)
|
(0%)
|
(0%)
|
(33%)
|
Conclusion: In contrast to AAHC, K. oxytoca is not associated with non-hemorrhagic AAD.
Testing for K. oxytoca is therefore only warranted in patients with bloody diarrhea and a history suspicious of AAHC.
