Almanac of Clinical MedicineAlmanac of Clinical MedicineАльманах клинической медицины2072-05052587-9294Moscow Regional Research and Clinical Institute (MONIKI)88010.18786/2072-0505-2018-46-5-497-503POINT OF VIEWТОЧКА ЗРЕНИЯToxin-producing Klebsiella oxytoca as a cause of antibiotic-associated colitisТоксин-продуцирующие Klebsiella oxytoca как причина антибиотик-ассоциированного колитаZakharenkoS. M.ЗахаренкоС. М.
Russian Federation

Sergei M. Zakharenko - MD, PhD, Associate Professor, Deputy Head of the Department of Infectious Diseases (with the Course of Medical Parasitology and Tropical Diseases).

6G Akademika Lebedeva ul., Saint Petersburg, 194044.

Tel.: +7 (911) 225 77 34. 

Захаренко Сергей Михайлович – кандидат медицинских наук, доцент, заместитель начальника кафедры инфекционных болезней (с курсом медицинской паразитологии и тропических заболеваний).

194044, Санкт-Петербург, ул. Академика Лебедева.

Тел.: +7 (911) 225 77 34. 

zsm1@mail.ruMilitary Medical Academy named after S.M. KirovФГБВОУ ВО «Военно-медицинская академия имени С.М. Кирова» Минобороны России191120184654975031611201816112018Copyright ©; 2018, Zakharenko S.M.Copyright ©; 2018, Захаренко С.М.2018Zakharenko S.M.Захаренко С.М.https://creativecommons.org/licenses/by/4.0https://almclinmed.ru/jour/article/view/880

Antibiotic-associated diarrhea remains an unresolved problem in current medicine. In the last decade, in addition to idiopathic antibiotic-associated diarrhea, diseases caused by cytotoxin-producing Klebsiella oxytoca strains are becoming increasingly detected. Clinical manifestations of this infection may vary from relatively mild diarrhea without signs of hemocolitis to severe antibiotic-associated hemorrhagic colitis with predominant involvement of the right hemicolon. High prevalence of resistance to ciprofloxacin, tetracycline, gentamicin, amikacyne, and trimethoprim/sulfamethoxazole is associated with the presence of all adhesion genes of K. oxytoca and its greater cytotoxicity. The genes encoding the K. oxytoca cytotoxin (tilivalline) are a part of the pathogenicity island (PAI) and are similar to the clusters responsible for the biosynthesis of pyrrolobenzodiazepine and found in gram-positive bacteria. The most important pathogenicity factor related to the development of K. oxytoca-associated hemorrhagic colitis is a cytotoxin kleboxymycin, which is a tilivalline metabolite. The treatment strategy in K. oxytoca-associated hemorrhagic colitis is to withdraw the trigger antimicrobial agent, to refrain from administration of new antimicrobials, to administer rehydration and rational pathogenetically based therapy. Studies on the development of therapeutic bacteriophages against K. oxytoca are of pilot nature.

Антибиотик-ассоциированная диарея остается нерешенной проблемой современной медицины. Помимо идиопатической антибиотик-ассоциированной диареи в последнее десятилетие все чаще регистрируются заболевания, вызванные цитотоксин-продуцирующими штаммами Klebsiella oxytoca. Клинические проявления этой инфекции варьируют от относительно нетяжелой диареи без признаков гемоколита до тяжелого антибиотик-ассоциированного геморрагического колита с преимущественным поражением правой половины толстой кишки. Высокая распространенность устойчивости к ципрофлоксацину, тетрациклину, гентамицину, амикацину и триметоприму/сульфаметоксазолу ассоциирована с наличием у K. oxytoca всех генов адгезии и большей цитотоксичностью. Гены, кодирующие цитотоксин К. oxytoca (тиливаллин), являются частью островка патогенности (PAI) и похожи на кластеры, отвечающие за биосинтез пирролобензодиазепина, присутствующие у грамположительных бактерий. Важнейшим фактором патогенности, связанным с развитием K. oxytoca-ассоциированного геморрагического колита, оказался цитотоксин – метаболит тиливаллина клебоксимицин. Терапевтическая тактика при развитии K. oxytoca-ассоциированного геморрагического колита заключается в отмене триггерного антимикробного препарата, отказе от назначения новых антимикробных средств, назначении регидратационной и рациональной патогенетической терапии. Исследования по разработке лечебных бактериофагов против K. oxytoca носят пилотный характер.

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