scholarly journals Newborns with Bloody Stools—At the Crossroad between Efficient Management of Necrotizing Enterocolitis and Antibiotic Stewardship

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1467
Author(s):  
Marie Heyne-Pietschmann ◽  
Dirk Lehnick ◽  
Johannes Spalinger ◽  
Franziska Righini-Grunder ◽  
Michael Buettcher ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Antibiotic Treatment ◽  
Necrotizing Enterocolitis ◽  
Management Strategy ◽  
Treatment Guidelines ◽  
Food Protein ◽  
Antibiotic Exposure ◽  
Tertiary Center ◽  
Allergic Proctocolitis ◽  
Bloody Stools

The onset of bloody stools in neonates often results in antibiotic treatment for suspected necrotizing enterocolitis (NEC). Food protein-induced allergic proctocolitis (FPIAP) is an often-neglected differential diagnosis. We performed a retrospective analysis of antibiotic exposure at our tertiary center from 2011 to 2020 that included three time periods of differing antimicrobial stewardship goals. We compared these data with the conventional treatment guidelines (modified Bell’s criteria). In our cohort of 102 neonates with bloody stools, the length of antibiotic exposure was significantly reduced from a median of 4 to 2 days. The proportion of treated neonates decreased from 100% to 55% without an increase in negative outcomes. There were 434 antibiotic days. Following a management strategy according to modified Bell’s criteria would have led to at least 780 antibiotic days. The delayed initiation of antibiotic treatment was observed in 7 of 102 cases (6.9%). No proven NEC case was missed. Mortality was 3.9%. In conclusion, with FPIAP as a differential diagnosis of NEC, an observational management strategy in neonates with bloody stools that present in a good clinical condition seems to be justified. This may lead to a significant reduction of antibiotic exposure. Further prospective, randomized trials are needed to prove the safety of this observational approach.

Non-allergic benign infantile proctocolitis: a neglected nosographic entity

2021 ◽  
Vol 14 (10) ◽  
pp. e244918
Author(s):  
Mariannita Gelsomino ◽  
Dario Sinatti ◽  
Stefano Miceli Sopo
Keyword(s):  
Differential Diagnosis ◽  
Rectal Bleeding ◽  
Well Being ◽  
Warning Signs ◽  
Clinical Entity ◽  
Stool Consistency ◽  
Cow Milk ◽  
Food Protein ◽  
Allergic Proctocolitis ◽  
Bloody Stools

The presence of rectal bleeding in the first months of life is very often diagnosed as food protein-induced allergic proctocolitis (FPIAP). The symptoms typically start in infancy, and most cases resolve by age 12 months. Infants with FPIAP usually present bloody stools mixed with mucus, with or without reduced stool consistency. Most affected infants are generally healthy-appearing. We used the story of an infant with rectal bleeding as a reminder that there is also the possibility of a form of benign non-allergic proctocolitis that is not usually included in the differential diagnosis. In the absence of warning signs and in case of infant well-being, it should be the first clinical entity to suspect. Therefore, we suggest we should wait at least 2 months before starting to eliminate cow milk or other foods from the diet.

scholarly journals Food protein‐induced proctocolitis and enteropathy

2020 ◽  
Vol 2 (1) ◽  
pp. 55-58
Author(s):  
Jonathan S. Tam
Keyword(s):  
Early Childhood ◽  
Gastrointestinal Tract ◽  
Immunoglobulin E ◽  
Chronic Diarrhea ◽  
Signs And Symptoms ◽  
Food Allergies ◽  
Food Protein ◽  
Healthy Infants ◽  
Allergic Proctocolitis ◽  
Bloody Stools

Non-IgE (immunoglobulin E) mediated gastrointestinal food allergies include several separate clinical entities, including food protein‐induced allergic proctocolitis (FPIAP) and food protein‐induced enteropathy (FPE). Although FPIAP and FPE both primarily affect the gastrointestinal tract, their presentations are vastly different. FPIAP presents with bloody stools in otherwise healthy infants, whereas FPE presents with chronic diarrhea, vomiting, malabsorption, and hypoproteinemia. These both typically present in infancy and resolve by early childhood. Although the presenting signs and symptoms may be different, management is similar in that both require avoidance of the suspected causal food.

scholarly journals An Eschar-like souvenir from a journey to Colombia: Ecthyma gangrenosum as a differential diagnosis of tropical diseases in immunocompromised patients – a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gabriela M. Wiedemann ◽  
Jochen Schneider ◽  
Mareike Verbeek ◽  
Björn Konukiewitz ◽  
Christoph D. Spinner ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Differential Diagnosis ◽  
Antibiotic Treatment ◽  
Partial Remission ◽  
Combined Treatment ◽  
Lymphocytic Leukemia ◽  
Entire Body ◽  
Tropical Diseases ◽  
Ecthyma Gangrenosum ◽  
Skin Ulcers

Abstract Background Ecthyma gangrenosum (EG) is a cutaneous infectious disease characterized by eschar-like skin ulcers typically caused by Pseudomonas aeruginosa. Here, we report a case of relapsing EG in a patient who had returned from a trip to Colombia, thus establishing EG as an important differential diagnosis of tropical diseases, and demonstrating that even long-term antibiotic treatment can result in only partial remission of EG. Case presentation A 77-year-old man with underlying chronic lymphocytic leukemia (CLL) on ibrutinib treatment was admitted because of a superinfected mosquito bite on the left ear and multiple partially necrotic skin lesions disseminated all over the entire body five days after returning from a trip to Colombia. The initial clinical suspicion of a tropical disease (leishmaniosis, systemic mycosis, or others) could not be confirmed. During the diagnostic workup, microbiological cultures of the skin biopsies and bronchoalveolar lavage revealed Pseudomonas aeruginosa, leading to a diagnosis of EG. Initial antibiotic treatment resulted in partial remission. However, the patient had to be re-admitted due to a relapse 3–4 weeks after the first episode. Finally, the patient was successfully treated with a combined approach consisting of antibiotics, recurrent surgical incisions, and administration of immunoglobulins. Conclusions In conclusion, EG should be considered as a differential diagnosis in immunosuppressed patients presenting with eschar-like skin ulcers. A combined treatment approach seems to be the best choice to achieve clinical cure and avoid relapse.

Increased IgE-Mediated Food Allergy With Food Protein-Induced Allergic Proctocolitis

PEDIATRICS ◽  
2021 ◽  
Vol 148 (Supplement 3) ◽  
pp. S35-S36
Author(s):  
Monica T. Kraft ◽  
David Stukus
Keyword(s):  
Food Allergy ◽  
Food Protein ◽  
Ige Mediated ◽  
Allergic Proctocolitis

scholarly journals Oral iron supplementation after antibiotic exposure induces a deleterious recovery of the gut microbiota

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Thibault Cuisiniere ◽  
Annie Calvé ◽  
Gabriela Fragoso ◽  
Manon Oliero ◽  
Roy Hajjar ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Antibiotic Treatment ◽  
Iron Supplementation ◽  
Pentose Phosphate ◽  
Oral Iron ◽  
Oral Antibiotic ◽  
Antibiotic Exposure ◽  
Microbiota Composition ◽  
Fecal Samples ◽  
Excess Iron

Abstract Background Oral iron supplementation is commonly prescribed for anemia and may play an important role in the gut microbiota recovery of anemic individuals who received antibiotic treatment. This study aims to investigate the effects of iron supplementation on gut microbiota recovery after antibiotics exposure. Results Mice were subjected to oral antibiotic treatment with neomycin and metronidazole and were fed diets with different concentrations of iron. The composition of the gut microbiota was followed throughout treatment by 16S rRNA sequencing of DNA extracted from fecal samples. Gut microbiota functions were inferred using PICRUSt2, and short-chain fatty acid concentration in fecal samples was assessed by liquid-chromatography mass spectrometry. Iron supplementation after antibiotic exposure shifted the gut microbiota composition towards a Bacteroidetes phylum-dominant composition. At the genus level, the iron-supplemented diet induced an increase in the abundance of Parasutterella and Bacteroides, and a decrease of Bilophila and Akkermansia. Parasutterella excrementihominis, Bacteroides vulgatus, and Alistipes finegoldii, were more abundant with the iron excess diet. Iron-induced shifts in microbiota composition were accompanied by functional modifications, including an enhancement of the biosynthesis of primary bile acids, nitrogen metabolism, cyanoamino acid metabolism and pentose phosphate pathways. Recovery after antibiotic treatment increased propionate levels independent of luminal iron levels, whereas butyrate levels were diminished by excess iron. Conclusions Oral iron supplementation after antibiotic therapy in mice may lead to deleterious changes in the recovery of the gut microbiota. Our results have implications on the use of oral iron supplementation after antibiotic exposure and justify further studies on alternative treatments for anemia in these settings.

scholarly journals Adherence to International Empiric Antibiotic Treatment Guidelines in a Tertiary Teaching Hospital in Mexico City

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Marco Antonio Rodríguez-Cervera ◽  
Paulo Francisco Castañeda-Mendez ◽  
Luis Soto-Ramírez ◽  
Lorena Cabrera-Ruiz
Keyword(s):  
Mexico City ◽  
Antibiotic Treatment ◽  
Teaching Hospital ◽  
Treatment Guidelines ◽  
Tertiary Teaching ◽  
Empiric Antibiotic ◽  
Tertiary Teaching Hospital ◽  
Empiric Antibiotic Treatment
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