The normal microflora and antibiotic-associated diarrhoea and colitis

  • S. P. Borriello
  • C. Roffe
Chapter

Abstract

Normal gut structure and function is the end-product of a complex set of interactions between the host and the complex microflora that inhabits the gastrointestinal tract. This balanced interaction is subjected both directly and indirectly to environmental influences, such as dietary factors, which can affect gut function directly through effects on the host or indirectly by effects on the gut microflora. In many cases these are an interactive loop of cause and effect whereby changes to the host alter the gut microflora, which in turn influences gut function. The ‘environmental’ factor that is most likely to have a significant direct impact on the gut microflora is antibiotic treatment.

Keywords

Bile Acid Clostridium Difficile Infection Clostridium Difficile Pseudomembranous Colitis Secondary Bile Acid 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Abrams, G. D. and Bishop, J. E. (1966) Effect of the normal microbial flora on the resistance of the small intestine to infections. Journal of Bacteriology, 92, 1604–1608.PubMedGoogle Scholar
  2. Amon, H. V. and Phillips, S. F. (1973) Inhibition of colonic water and electrolyte absorption by fatty acids in man. Gastroenterology, 65, 744–749.Google Scholar
  3. Bartlett, J. G., Tedesco, F. J., Shull, S. et al. (1980) Symptomatic relapse after oral vancomycin therapy of antibiotic-associated pseudomembranous colitis. Gastroenterology, 78, 431–434.PubMedGoogle Scholar
  4. Biller, J. A., Katz. A. J., Flores, A. F. et al. (1995) Treatment of recurrent Clostridium difficile colitis with Lactobacillus GG. Journal of Pediatric Gastroenterology and Nutrition, 21, 224–226.PubMedCrossRefGoogle Scholar
  5. Binder, H. J. and Rawlins, C. L. (1973) Effect of conjugated bile salts on electrolyte ransport in rat colon. Journal of Clinical Investigation, 52, 1460–1466.PubMedCrossRefGoogle Scholar
  6. Borriello, S. P. (1984a) Bacteria and gastrointestinal secretion and motility. Scandinavian Journal of Gastroenterology, 19 (Suppl. 93), 115–121.Google Scholar
  7. Borriello, S. P. (ed.) (1984b) Antibiotic-Associated Diarrhoea and Colitis. Martinus Nijhoff, Boston, MA.Google Scholar
  8. Borriello, S. P. (1989) Influence of the normal gut flora of the gut on Clostridium ifficile, in The Regulatory and Protective Role of the Normal Microflora, (eds. Grubb, T. Midtvedt and E. Norrin ), Macmillan, Basingstoke, pp 239–251.Google Scholar
  9. Borriello, S. P. (1990) Pathogenesis of Clostridium difficile infection of the gut. ournal of Medical Microbiology, 33, 207–215.Google Scholar
  10. Borriello, S. P. (1992) Possible mechanisms of action of antimicrobial agent-associated gastrointestinal symptoms. Postgraduate Medical Journal, 68 (Suppl. 3), S38 — S42.PubMedGoogle Scholar
  11. Borriello, S. P. (1998) Pathogenesis of Clostridium difficile infection. Journal of Antimicrobial Chemotherapy,in press.Google Scholar
  12. Borriello, S. P. and Barclay, F. E. (1985) Protection of hamsters against Clostridium difficile ileocaecitis by prior colonisation with non-pathogenic strains. Journal of Medical Microbiology, 19, 339–349.PubMedCrossRefGoogle Scholar
  13. Borriello, S. P. and Barclay, F. E. (1986) An in-vitro model of colonisation resistance to Clostridium difficile infection. Journal of Medical Microbiology, 21, 299–309.PubMedCrossRefGoogle Scholar
  14. Borriello, S. P. and Carman, R. J. (1988) Other clostridial causes of diarrhoea and colitis in man and animals, in Clostridium difficile: Its Role in Intestinal Disease, (eds R. D. Rolfe and S. M. Finegold ), Academic Press, San Diego, CA, pp. 65–98.Google Scholar
  15. Borriello, S. P., Barclay, F. E. and Welch, A. R. (1988) Evaluation of the predictive capability of an in-vitro model of colonisation resistance to Clostridium difficile infection. Microbiology Ecology in Health and Disease, 1, 61A.CrossRefGoogle Scholar
  16. Borriello, S. P., Larson, H. E., Welch, A. R. et al. (1984) Enterotoxigenic Clostridium perfringens: a possible cause of antibiotic-associated diarrhoea. Lancet, i, 305–307.Google Scholar
  17. Borriello, S. P., Barclay, F. E., Welch, A. R. et al. (1985a) Host and microbial determinants of the spectrum of Clostridium difficile mediated gastrointestinal disorders. Microecology and Therapy, 15, 231–236.Google Scholar
  18. Borriello, S. P., Barclay, F. E., Welch, A. R. et al. (1985b) Epidemiology of diarrhoea caused by enterotoxigenic Clostridium perfringens. Journal of Medical Microbiology, 20, 363–372.CrossRefGoogle Scholar
  19. Boureau, H., Salanon, C., Decaaens, C. and Bourlioux, P. (1994) Caecal localisation of the specific microbiota resistant to Clostridium difficile colonisation in gnotobiotic mice. Microbial Ecology in Health and Disease, 7, 111–117.CrossRefGoogle Scholar
  20. Bowden, T. A., Mansberger, A. R. and Lykins, L. E. (1981) Pseudomembranous enterocolitis: mechanism of restoring flora homeostasis. American Surgeon, 47, 178–183.PubMedGoogle Scholar
  21. Bright-Asare, P. and Binder, H. J. (1973) Stimulation of colonic secretion of water and electrolytes by hydroxy fatty acids. Gastroenterology, 64, 81–88.PubMedGoogle Scholar
  22. Buts, J.-P., Corthier, G. and Delmee, M. (1993) Saccharomyces boulardii for Clostridium difficile associated enteropathies in infants. Journal of Pediatric Gastroenterology and Nutrition, 16, 419–425.Google Scholar
  23. Cano, N., Chapoy, P. and Corthier, G. (1989) Saccharomyces boulardii: un traitment des colites pseudomembraneuses? Presse Medicale, 18, 1299.Google Scholar
  24. Castagliuolo, I., LaMont, J. T., Nikulasson, S. T. and Pothoulakis, C. (1996) Saccharomyces boulardii protease inhibits Clostridium difficile toxin A effects in the rat ileum. Infection and Immunity, 64, 5225–5232.Google Scholar
  25. Cherry, R. D., Portnoy, D., Jabbari, M. et al. (1982) Metronidazole: an alternative therapy for antibiotic-associated colitis. Gastroenterology, 82, 849–851.PubMedGoogle Scholar
  26. Chia, J. K. S., Chan, S. M. and Goldstein, H. (1995) Baker’s yeast as adjunctive therapy for relapses of Clostridium difficile diarrhoea. Clinical Infectious Diseases, 20, 1581.PubMedCrossRefGoogle Scholar
  27. Clausen, M. R., Bronnen, H., Tvede, M. and Mortensen, P. B. (1991) Colonic fermentation to short-chain fatty acids is decreased in antibiotic-associated diarrhoea. Gastroenterology, 101, 1497–1504.PubMedGoogle Scholar
  28. Corthier, G. Dubos, F. and Ducluzeau, R. (1986) Prevention of Clostridium difficile mortality in gnotobiotic mice by Saccharomyces boulardii. Canadian Journal of Microbiology, 32, 894–896.Google Scholar
  29. Corthier, G. Dubos, F. and Raibaud, P. (1985) Modulation of cytotoxin production by Clostridium difficile in the intestinal tracts of gnotobiotic mice inoculated with various human intestinal bacteria. Applied and Environmental Microbiology, 49, 250–252.PubMedGoogle Scholar
  30. Dubos, F., Martinet, L., Dabard, J. and Ducluzeau, R. (1984) Immediate postnatal inoculation of a microbial barrier to prevent neonatal diarrhoea induced by Clostridium difficile in young conventional and gnotobiotic hares. American Journal of Veterinary Research, 45, 1241–1244.Google Scholar
  31. Ducluzeau, R., Dubos, F., Hudault, S. et al. (1981) Microbial barriers against enteropathogenic strains in the digestive tract of gnotoxenic animals. Application to the treatment of Clostridium difficile diarrhoea in the young hare, in Recent dvances in Germ free Research, (eds A. Sasaki, K. Ozawa and K. Hashimoto ), Tokai University Press, Tokyo.Google Scholar
  32. Eisemann, B., Silem, W., Bascomb, W. S. and Kanvor, A. J. (1958) Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis. Surgery, 44, 854–858.Google Scholar
  33. Gorbach, S. L., Chang, T.-W. and Goldin, B. (1987) Successful treatment of relapsing Clostridium difficile colitis with Lactobacillus GG. Lancet, ii, 1519.Google Scholar
  34. Gracy, M., Papadimitriou, J. and Bower, G. (1974) Ultrastructural changes in the mall intestine of rats with self-filling blind loops. Gastroenterology, 67, 646–651.Google Scholar
  35. Hofmann, A. F. (1967) The syndrome of ileal disease and the broken enterohepatic irculation: cholerheic enteropathy. Gastroenterology, 52, 752–757.PubMedGoogle Scholar
  36. Itoh, K., Lee, W. K., Kawamura, H. et al. (1987) Intestinal bacteria antagonistic to Clostridium difficile in mice. Laboratory Animal, 21, 20–25.CrossRefGoogle Scholar
  37. James, AT., Webb, J. P. W. and Kellock, T. D. (1961) The occurrence of unusual fatty acids in faecal lipids from human beings with normal and abnormal fat absorption. Biochemical Journal, 78, 333–339.PubMedGoogle Scholar
  38. Keighley, M. R. B., Burdon, D. W., Arabi, Y. et al. (1978) Randomised controlled trial of vancomycin for pseudomembranous colitis and post-operative diarrhoea. British Medical Journal, ii, 1667–1669.Google Scholar
  39. Kimmey, M. B., Elmer, G. W., Surawicz, C. M. and McFarland, L. V. (1990) Prevention of further recurrences of Clostridium difficile colitis with Saccharomyces boulardii. Digestive Diseases and Sciences, 35, 897–901.CrossRefGoogle Scholar
  40. Kirwan, W. O., Smith, A. N., Mitchell, W. D. et al. (1975) Bile acids and colonic otility in the rabbit and the human. Part 1. The rabbit. Gut, 16, 894–902.PubMedCrossRefGoogle Scholar
  41. Larson, H. E. and Borriello, S. P. (1988) Infectious diarrhoea due to Clostridium perfringens. Journal of Infectious Diseases, 157, 390–391.Google Scholar
  42. Larson, H. E. and Borriello, S. P. (1990) Quantitative study of antibiotic induced susceptibility to Clostridium difficile enterocolitis in hamsters. Antimicrobial Agents and Chemotherapy, 34, 1348–1353.PubMedCrossRefGoogle Scholar
  43. Larson, H. E., Price, A. B. and Borriello, S. P. (1980) Epidemiology of experimental enterocecitis due to Clostridium difficile. Journal of Infectious Diseases, 142, 408–413.Google Scholar
  44. Larson, H. E., Barclay, F. E., Honour, P. and Hill I. D. (1982) Epidemiology of Clostridium difficile in infants. Journal of Infectious Diseases, 146, 727–733.PubMedCrossRefGoogle Scholar
  45. Lewis, S. J., Potts, L. F. and Barry, R. E. (1998) The therapeutic effects of Saccharomyces boulardii in the prevention of antibiotic related-diarrhoea in elderly patients. Journal of Hospital Infection,36, in press.Google Scholar
  46. Libby, J. M., Donta, S. T. and Wilkins, T. D. (1983) Clostridium difficile toxin A in infants. Journal of Infectious Diseases, 148, 606.Google Scholar
  47. Lyerly, D. M., Krivan, H. E. and Wilkins, T. D. (1988) Clostridium difficile its disease and toxins. Clinical Microbiology Reviews,1–18.Google Scholar
  48. McFarland, L. V. and Bernasconi, P. (1993) Saccharomyces boulardii: a review of an innovative biotherapeutic agent. Microbial Ecology in Health and Disease, 6, 157–171.Google Scholar
  49. McFarland, L. V., Surawicz, C. M., Greenberg, R. N. et al. (1994) A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. Journal of the American Medical Association, 271, 1913–1918.PubMedCrossRefGoogle Scholar
  50. Mekhjian, H. S., Phillips, S. F. and Hofmann, A. F. (1971) Colonic secretion of water and electrolytes induced by bile acids: perfusion studies in man. Journal of Clinical Investigation, 50, 1569–1577.CrossRefGoogle Scholar
  51. Pen, J. and Welling, G. W. (1981) The concentration of cholecystokinin in the intestinal tract of germ-free and control mice. Antonie van Leeuwenhoek, 47, 84–85.PubMedCrossRefGoogle Scholar
  52. Pothoulakis, C., Kelly, C. P., Joshi, M. A. et al. (1993) Saccharomyces boulardii inhibits Clostridium difficile toxin A binding and enterotoxicity in rat ileum. Gastroenterology, 104, 1108–1115.Google Scholar
  53. Raibaud, P., Ducluzeau R., Dubos, F. et al. (1980) Implantation of bacteria from the digestive tract of man and various animals into gnotobiotic mice. American Journal of Clinical Nutrition, 33, 2440–2447.PubMedGoogle Scholar
  54. Rolfe, R. D. (1984) Role of volatile fatty acids in colonisation resistance to Clostridium difficile. Infection and Immunity, 45, 185–191.Google Scholar
  55. Rolfe, R. D. and Finegold, S. M. (eds) (1988) Clostridium difficile: Its Role in Intestinal Disease. Academic Press, San Diego, CA.Google Scholar
  56. Schellenberg, D., Bonington, A., Champion, C. M. et al. (1994) Treatment of relapsing Clostridium difficile diarrhoea with brewer’s yeast. Lancet, 343, 171–172.PubMedCrossRefGoogle Scholar
  57. Schwan, A., Sjolin, S., Trottestam, U. and Aronsson, B. (1984) Relapsing Clostridium difficile enterocolitis cured by rectal infusion of normal faeces. Scandinavian Journal of Infectious Diseases, 16, 211–215.PubMedCrossRefGoogle Scholar
  58. Seal, D. V., Borriello, S. P., Barclay, F. et al. (1987) Treatment of relapsing Clostridium difficile diarrhoea by administration of a non-toxigenic strain. European Journal of Clinical Microbiology, 6, 51–53.PubMedCrossRefGoogle Scholar
  59. Seddon, S. V., Hemingway, I. and Borriello, S. P. (1990) Hydrolytic enzyme production by Clostridium difficile and its relationship to toxin production and virulence in the hamster model. Journal of Medical Microbiology, 31, 169–174.PubMedCrossRefGoogle Scholar
  60. Surawicz, C. M., Elmer, G. M., Speelman, P. et al. (1989a) Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: a prospective study. Gastroenterology, 96, 981–988.PubMedGoogle Scholar
  61. Surawicz, C. M., McFarland, L. V., Elmer, G. W. and Chirm, J. (1989b) Treatment of recurrent Clostridium difficile colitis with vancomycin and Saccharomyces boulardii. American Journal of Gastroenterology,84 1285–1287.Google Scholar
  62. Siitonen, S., Vapaatalo, H., Salminen, S. et al. (1990) Effect of Lactobacillus GG yoghurt in prevention of antibiotic associated diarrhoea. Annals of Medicine, 22, 57–59.PubMedCrossRefGoogle Scholar
  63. Toothaker, R. D. and Elmer, G. W. (1984) Prevention of clindamycin-induced mortality in hamsters by Saccharomyces boulardii. Antimicrobial Agents and Chemotherapy, 26, 552–556.CrossRefGoogle Scholar
  64. Tvede, M. and Rask-Maden, J. (1989) Bacteriotherapy for chronic relapsing Clostridium difficile diarrhoea in six patients. Lancet,i 1156–1160.Google Scholar
  65. Wilcox, H. M. and Spencer, R. C. (1992) Clostridium difficile infection: responses, relapses and re-infections. Journal of Hospital Infection, 22, 85–92.Google Scholar
  66. Williams, R., Piper, M., Borriello, S. P. et al. (1985) Diarrhoea due to enterotoxigenic Clostridium perfringens: clinical features and management of a cluster often cases. Age and Ageing, 14, 296–302.PubMedCrossRefGoogle Scholar
  67. Wilson, K. H. and Freter, R. (1986) Interaction of Clostridium difficile and Escherichia coli with microfloras in continuous-flow cultures and gnotobiotic mice. Infection and Immunity, 54, 354–358.PubMedGoogle Scholar
  68. Wilson, K. H. and Perini, F. (1988) Role of competition for nutrients in suppression of Clostridium difficile by the colonic microflora. Infection and Immunity, 56, 2610–2614.PubMedGoogle Scholar
  69. Wilson, K. H. and Sheagren, J. N. (1983) Antagonism of toxigenic Clostridium difficile by non-toxigenic C. difficile. Journal of Infectious Diseases,147 733–736.Google Scholar
  70. Wilson, K. H., Silva, J. and Fekety, R. F. (1981) Suppression of Clostridium difficile by normal hamster cecal flora and prevention of antibiotic-associated cecitis. Infection and Immunity, 34, 626–628.Google Scholar
  71. Wilson, K. H., Sheagren, J. N., Freter, R. et al. (1986) Gnotobiotic models for study of the microbial ecology of Clostridium difficile and Escherichia coli. Journal of Infectious Diseases,153 547–551.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1999

Authors and Affiliations

  • S. P. Borriello
  • C. Roffe

There are no affiliations available

Personalised recommendations