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Disturbed intestinal microbiota (dysbiosis) and micro dynamics in patients treated for appendicitis and diverticulitis
Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Microbiology. Östergötlands Läns Landsting, Center for Health and Developmental Care, Department of Infection Control.
Department of Microbiology, Tumor and Cellbiology, Karolinska Institute, Solna, Sweden.
Department of Microbiology, Tumor and Cellbiology, Karolinska Institute, Solna, Sweden.
Center for Family Medicine, Karolinska Institute, Huddinge, Sweden.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction: The human gut microbiota is a large dynamic bacterial community, which is influenced by for instance antibiotic treatment and hospitalization. In patients with inflammatory bowel disease the diversity of gut microbiota is thought to be less diverse. The role of the gut microbiota in acute appendicitis and diverticulitis is still unclear. To investigate the microbial diversity in patients suffering from appendicitis or diverticulitis, and the microbiota dynamics after antibiotic therapy and hospitalization we performed an open observation study.

Methods and population: We have performed 16S rRNA sequence analysis on 42 individuals diagnosed with appendicitis and 18 individuals with diverticulitis as well as 33 healthy controls. Cultivation of the aerobic bacterial flora was performed as a complement to sequence analysis.

Results: In sequencing data at genus level, there are distinctive differences when comparing healthy controls to patients diagnosed with appendicitis. Healthy controls have a flora dominated by Bacteroides, and Faecalibacterium, Ruminococcus and Prevotella while appendicitis patients show an intestinal flora with a higher abundance of Escherichia/Shigella and unclassified Enterobacteriaceae. The same pattern, however not quite as distinct could be seen for the diverticulitis patients. The microbial diversity increases after treatment with antibiotics and hospitalization.

In the cultivated aerobic flora there was a significant loss of Escherichia coli and a significant gain of Citrobacter species, in the appendicitis group. In the appendicitis group as well as in the diverticulitis group there was a significant gain of Enterococcus faecium and Yeasts.

Conclusion: The main findings of this study are that patients arriving at the emergency department with acute appendicitis or diverticulitis have an already significant disturbed fecal microbiota previous to antibiotic treatment and hospitalization.

National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-97708OAI: diva2:650222
Available from: 2013-09-20 Created: 2013-09-20 Last updated: 2013-09-20Bibliographically approved
In thesis
1. The faecal flora: a source of healthcare-associated infections and antibiotic resistance
Open this publication in new window or tab >>The faecal flora: a source of healthcare-associated infections and antibiotic resistance
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Healthcare-associated infections (HAI) are important causes of mortality and morbidity, and antibiotic treatment is often necessary. Development and availability of new antibiotics are closely followed by development of resistance among microorganisms. During antibiotic therapy, a fraction of the antibiotic given is found in the gut. The human gut is an important reservoir of bacteria. Microorganisms residing or passing the gut is referred to as the gut flora or microbiota. The results of this thesis showed spread of Enterococcus spp between patients on a general intensive care unit, causing septicaemia. After improved hygiene, reorganisation of rooms and thorough cleaning of the unit, together with revision of antibiotic strategy, the incidence of septicaemia with Enterococcus spp fell. Investigation of patients treated for acute intra-abdominal infections showed a shift in the aerobic faecal flora from antibiotic-susceptible Enterobacteriaceae spp towards Enterococcus faecium, yeasts and species of Enterobacteriaceae more resistant to antibiotics, after antibiotic treatment and hospital care. Investigation of recurrent outbreaks of Serratia marcescens sepsis in patients admitted to a neonatal intensive care unit showed different clones with each outbreak. Multiple hygiene interventions and revision of antibiotic strategy subsequently obviated recurrent outbreaks of sepsis, but spread of S. marcescens was not reduced until compliance with basic hygiene guidelines remained stable above 80%. We also found that low gestational age at birth, ventilator treatment and central venous or umbilical catheters are independent risk factors for late onset sepsis. Investigation of the faecal microbiota in patients with acute appendicitis or diverticulitis revealed that disturbance of the faecal microbiota already existed on admission, with higher numbers of Enterobacteriaceae and less Bacteroides, Faecalibacterium, Ruminococcus and Prevotella prior to antibiotic treatment and hospitalisation, than the control population. After treatment and hospitalisation diversity increased significantly in the diverticulitis group, approaching the healthy controls in composition.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 82 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1368
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-97709 (URN)10.3384/diss.diva-97709 (DOI)978-91-7519-591-9 (print) (ISBN)
Public defence
2013-10-11, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 13:00 (Swedish)
Available from: 2013-09-20 Created: 2013-09-20 Last updated: 2013-12-03Bibliographically approved

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Samuelsson, AnnikaHanberger, Håkan
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Clinical MicrobiologyFaculty of Health SciencesDepartment of Clinical MicrobiologyDepartment of Infection ControlInfectious DiseasesDepartment of Infectious Diseases
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