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Title:   Author  item
                                            Harvey, Rogeritem
                                            Andrews, Kathleen

                                                         - *Kate*item
                                            Droleskey, Robert

                                                         - *Bob*item
                                            KANSAGRA, K - ARS CHILDREN'S NUTRITIONitem
                                            STOLL, B - ARS CHILDREN'S NUTRITIONitem
                                            Burrin, Douglas

                                                         - *Doug*item
                                            Genovese, Kenneth

                                                         - *Ken*item
                                            Edrington, Thomasitem
                                            Anderson, Robinitem
                                            Nisbet, David
  Submitted to: Proceedings of the International Symposium on Digestive Physiology in Pigs
                                    Publication Type: Abstract Only
                                    Publication Acceptance Date: 1/15/2003
                                    Publication  Date: N/A
                                    Citation: N/AInterpretive Summary:
                                Technical Abstract: Pseudomembranous colitis and sepsis from Clostridium difficile have been associated with total parenteral nutrition (TPN) and high dosages of antibiotics in preterm human infants.  In this study, we used a neonatal pig model and compared the effects of TPN versus enteral (ENT) feeding on intestinal bacterial colonization.  Newborn, colostrums-deprived pigs (<24h old) were fitted with intravenous catheters and divided into two groups.  One group (n = 13) received TPN through intravenous feeding and the second group (n = 14) was orally fed a commercial pig milk-replacer (ENT); the nutrient intake did not differ between groups.  After 7 d of treatment, pigs were euthanized and jejunum (J), ilieum (I), and cecum (C) were evaluated using restrictive media and serial dilutions to determine the presence and concentrations of enteric bacteria. The ENT group had increased bacterial concentration and diversity of bacterial species compared to the TPN group.  The J, I, and C in the ENT group were colonized by at least 7 species of enteric bacteria whereas the majority of isolates from the TPN group were Enterococci and Clostridia from the C.  The ENT group had 1/14 positive samples for C. difficile toxin A whereas the TPN group had 5/13 C. difficile-toxin A positive samples.  It is known that individual bacteria or yeasts or a mixture of GI tract commensals can suppress C. difficile populations and reduce morbidity and mortality from C. difficile in humans, mice, hamsters, and hares.  On the basis of our results, we propose that the presence of gut nutrients in the ENT group enhanced the colonization of the GI tract with commensal bacteria and thereby suppressed the proliferation of C. difficile.  We suggest that TPN reduced the onset of gut colonization, which in turn, favored the growth of C. difficile.  TPN-treated neonates may be at a higher risk for colonization by C. difficile.


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