title: Spectrum and antibiotic sensitivity of bacteria contaminating the upper gut in patients with malabsorption syndrome from the tropics.
abstract: BACKGROUND
  Various causes of malabsorption syndrome (MAS) are associated with intestinal stasis that may cause small intestinal bacterial overgrowth (SIBO). Frequency, nature and antibiotic sensitivity of SIBO in patients with MAS are not well understood.
  
  
  METHODS
  Jejunal aspirates of 50 consecutive patients with MAS were cultured for bacteria and colony counts and antibiotic sensitivity were performed. Twelve patients with irritable bowel syndrome were studied as controls.
  
  
  RESULTS
  Culture revealed growth of bacteria in 34/50 (68%) patients with MAS and 3/12 controls (p < 0.05). Colony counts ranged from 3 x 10(2) to 10(15) (median 10(5)) in MAS and 100 to 1000 (median 700) CFU/ml in controls (p 0.003). 21/50 (42%) patients had counts GreaterEqual;105 CFU/ml in MAS and none of controls (p < 0.05). Aerobes were isolated in 34/34 and anaerobe in 1/34. Commonest Gram positive and negative bacteria were Streptococcus species and Escherichia coli respectively. The isolated bacteria were more often sensitive to quinolones than to tetracycline (ciprofloxacin: 39/47 and norfloxacin: 34/47 vs. tetracycline 19/47, <0.01), ampicillin, erythromycin and co-trimoxazole (21/44, 14/22 and 24/47 respectively vs. tetracycline, p = ns).
  
  
  CONCLUSIONS
  SIBO is common in patients with MAS due to various causes and quinolones may be the preferred treatment. This needs to be proved further by a randomized controlled trial.
authors.affiliation: Department of Microbiology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow 226014, India. ujjala@sgpgi.ac.in
authors.forename: Ujjala
authors.initials: U
authors.lastname: Ghoshal
authors.forename: Uday C
authors.initials: UC
authors.lastname: Ghoshal
authors.forename: Piyush
authors.initials: P
authors.lastname: Ranjan
authors.forename: Subhash R
authors.initials: SR
authors.lastname: Naik
authors.forename: Archana
authors.initials: A
authors.lastname: Ayyagari
mesh_terms: D000328:Adult; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000188:drug therapy / Q000382:microbiology; D007583:Jejunum / Q000382:microbiology*; D008286:Malabsorption Syndromes / Q000188:drug therapy* / Q000382:microbiology*; D008297:Male; D008826:Microbial Sensitivity Tests; D013291:Streptococcus / Q000187:drug effects / Q000302:isolation & purification