Cytotoxin-producing Klebsiella oxytoca in the preterm gut and its association with necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is a devastating intestinal inflammatory disease of premature infants associated with gut bacterial dysbiosis. Using 16S rRNA-based methods, our laboratory identified an unclassified Enterobacteriaceae sequence (NEC_unk_OTU) with high abundance in NEC fecal samples. W...

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Main Authors: Sara Paveglio, Nagender Ledala, Karim Rezaul, Qingqi Lin, Yanjiao Zhou, Anthony A. Provatas, Erin Bennett, Tristan Lindberg, Melissa Caimano, Adam P. Matson
Format: Article
Language:English
Published: Taylor & Francis Group 2020-01-01
Series:Emerging Microbes and Infections
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Online Access:https://www.tandfonline.com/doi/10.1080/22221751.2020.1773743
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author Sara Paveglio
Nagender Ledala
Karim Rezaul
Qingqi Lin
Yanjiao Zhou
Anthony A. Provatas
Erin Bennett
Tristan Lindberg
Melissa Caimano
Adam P. Matson
author_facet Sara Paveglio
Nagender Ledala
Karim Rezaul
Qingqi Lin
Yanjiao Zhou
Anthony A. Provatas
Erin Bennett
Tristan Lindberg
Melissa Caimano
Adam P. Matson
author_sort Sara Paveglio
collection DOAJ
description Necrotizing enterocolitis (NEC) is a devastating intestinal inflammatory disease of premature infants associated with gut bacterial dysbiosis. Using 16S rRNA-based methods, our laboratory identified an unclassified Enterobacteriaceae sequence (NEC_unk_OTU) with high abundance in NEC fecal samples. We aimed to identify this bacterium and determine its potential role in the disease. NCBI database searches for the 16S sequence, selective culture systems, biotyping and polymerase chain reaction were employed to refine classification of NEC_unk_OTU and identify toxin-encoding genes from the index NEC case. Bacterial cytotoxin production was confirmed by mass spectrometry and apoptosis assays. Additional fecal samples from 9 NEC and 5 non-NEC controls were analyzed using similar methods and multi-locus sequence typing (MLST) was performed to investigate clonal relationships and define sequence types of the isolates. NEC_unk_OTU was identified as Klebsiella oxytoca, a pathobiont known to cause antibiotic-associated hemorrhagic colitis, but not previously linked to NEC. Including the index case, cytotoxin-producing strains of K. oxytoca were isolated from 6 of 10 subjects with NEC; in these, the K. oxytoca 16S sequence predominated the fecal microbiota. Cytotoxin-producing strains of K. oxytoca also were isolated from 4 of 5 controls; in these, however, the abundance of the corresponding 16S sequence was very low. MLST analysis of the toxin-positive isolates demonstrated no clonal relationships and similar genetic clustering between cases and controls. These results suggest cytotoxin-producing strains of K. oxytoca colonize a substantial proportion of premature infants. Some, perhaps many, cases of NEC may be precipitated by outgrowth of this opportunistic pathogen.
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spelling doaj-art-ba2f0102f5df48a4b4afd679be31eea82025-08-20T02:26:30ZengTaylor & Francis GroupEmerging Microbes and Infections2222-17512020-01-01911321132910.1080/22221751.2020.1773743Cytotoxin-producing Klebsiella oxytoca in the preterm gut and its association with necrotizing enterocolitisSara Paveglio0Nagender Ledala1Karim Rezaul2Qingqi Lin3Yanjiao Zhou4Anthony A. Provatas5Erin Bennett6Tristan Lindberg7Melissa Caimano8Adam P. Matson9Division of Neonatology, Connecticut Children’s Medical Center, Hartford, CT, USADepartment of Pediatrics, UConn Health, Farmington, CT, USA*Department of Pediatrics, UConn Health, Farmington, CT, USA*Department of Computer Science and Engineering, University of Connecticut, Storrs, CT, USADepartment of Medicine, UConn Health, Farmington, CT, USACenter for Environmental Sciences and Engineering, University of Connecticut, Storrs, CT, USADepartment of Research, Connecticut Children’s Medical Center, Hartford, CT, USADivision of Neonatology, Connecticut Children’s Medical Center, Hartford, CT, USADepartment of Pediatrics, UConn Health, Farmington, CT, USA*Division of Neonatology, Connecticut Children’s Medical Center, Hartford, CT, USANecrotizing enterocolitis (NEC) is a devastating intestinal inflammatory disease of premature infants associated with gut bacterial dysbiosis. Using 16S rRNA-based methods, our laboratory identified an unclassified Enterobacteriaceae sequence (NEC_unk_OTU) with high abundance in NEC fecal samples. We aimed to identify this bacterium and determine its potential role in the disease. NCBI database searches for the 16S sequence, selective culture systems, biotyping and polymerase chain reaction were employed to refine classification of NEC_unk_OTU and identify toxin-encoding genes from the index NEC case. Bacterial cytotoxin production was confirmed by mass spectrometry and apoptosis assays. Additional fecal samples from 9 NEC and 5 non-NEC controls were analyzed using similar methods and multi-locus sequence typing (MLST) was performed to investigate clonal relationships and define sequence types of the isolates. NEC_unk_OTU was identified as Klebsiella oxytoca, a pathobiont known to cause antibiotic-associated hemorrhagic colitis, but not previously linked to NEC. Including the index case, cytotoxin-producing strains of K. oxytoca were isolated from 6 of 10 subjects with NEC; in these, the K. oxytoca 16S sequence predominated the fecal microbiota. Cytotoxin-producing strains of K. oxytoca also were isolated from 4 of 5 controls; in these, however, the abundance of the corresponding 16S sequence was very low. MLST analysis of the toxin-positive isolates demonstrated no clonal relationships and similar genetic clustering between cases and controls. These results suggest cytotoxin-producing strains of K. oxytoca colonize a substantial proportion of premature infants. Some, perhaps many, cases of NEC may be precipitated by outgrowth of this opportunistic pathogen.https://www.tandfonline.com/doi/10.1080/22221751.2020.1773743AntibioticsbacteriacytotoxinsKlebsiella oxytocamicrobiomenecrotizing enterocolitis
spellingShingle Sara Paveglio
Nagender Ledala
Karim Rezaul
Qingqi Lin
Yanjiao Zhou
Anthony A. Provatas
Erin Bennett
Tristan Lindberg
Melissa Caimano
Adam P. Matson
Cytotoxin-producing Klebsiella oxytoca in the preterm gut and its association with necrotizing enterocolitis
Emerging Microbes and Infections
Antibiotics
bacteria
cytotoxins
Klebsiella oxytoca
microbiome
necrotizing enterocolitis
title Cytotoxin-producing Klebsiella oxytoca in the preterm gut and its association with necrotizing enterocolitis
title_full Cytotoxin-producing Klebsiella oxytoca in the preterm gut and its association with necrotizing enterocolitis
title_fullStr Cytotoxin-producing Klebsiella oxytoca in the preterm gut and its association with necrotizing enterocolitis
title_full_unstemmed Cytotoxin-producing Klebsiella oxytoca in the preterm gut and its association with necrotizing enterocolitis
title_short Cytotoxin-producing Klebsiella oxytoca in the preterm gut and its association with necrotizing enterocolitis
title_sort cytotoxin producing klebsiella oxytoca in the preterm gut and its association with necrotizing enterocolitis
topic Antibiotics
bacteria
cytotoxins
Klebsiella oxytoca
microbiome
necrotizing enterocolitis
url https://www.tandfonline.com/doi/10.1080/22221751.2020.1773743
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