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Microbial Spectrum of Intra-Abdominal Abscesses in Perforating Crohn's Disease: Results from a Prospective German
P A Reuken1, W Kruis2, C Maaser3
1Department of Internal Medicine IV [Gastroenterology, Hepatology, and Infectious Diseases], Jena University Hospital, Jena, Germany.
Background:
Intra-abdominal abscesses [IAAs] are common life-threatening complications in patients with Crohn's disease [CD]. In addition to interventional drainage and surgical therapy, empirical antibiotic therapy represents a cornerstone of treatment, but contemporary data on microbial spectra and antimicrobial resistance are scarce.
Methods:
We recruited 105 patients with CD and IAAs from nine German centres for a prospective registry in order to characterize the microbiological spectrum, resistance profiles, antibiotic therapy and outcome.
Results:
In 92 of 105 patients, microbial investigations of abscess material revealed pathogenic microorganisms. A total of 174 pathogens were isolated, with a median of 2 pathogens per culture [range: 1-6]. Most frequently isolated pathogens were E. coli [45 patients], Streptococcus spp. [28 patients], Enterococci [27 patients], Candida [13 patients] and anaerobes [12 patients]. Resistance to third-generation cephalosporins, penicillins with beta-lactamase inhibitors and quinolones were observed in 51, 36 and 35 patients, respectively. Seven patients had multiple-drug-resistant bacteria. Thirty patients received inadequate empirical treatment, and this was more frequent in patients receiving steroids or immunosuppression [37%] than in patients without immunosuppression [10%: p = 0.001] and was associated with a longer hospital stay [21 days vs 13 days, p = 0.003].
Conclusion:
Based on antimicrobial resistance profiles, we herein report a high rate of inadequate empirical first-line therapy for IAAs in CD, especially in patients receiving immunosuppression, and this is associated with prolonged hospitalization.
Insights
Empirical antibiotic therapy for intra-abdominal abscesses in Crohn's disease is often inadequate, particularly for patients on immunosuppression. This leads to higher rates of resistance and prolonged hospital stays.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Intra-abdominal abscesses (IAAs) are frequent, life-threatening complications in Crohn's disease (CD) patients.
- Antibiotic therapy is crucial, but current data on microbial patterns and resistance are limited.
Purpose of the Study:
- To characterize the microbiological spectrum, resistance profiles, and antibiotic treatment outcomes in CD patients with IAAs.
Main Methods:
- A prospective registry of 105 CD patients with IAAs was conducted across nine German centers.
- Microbiological investigations of abscess material were performed.
Main Results:
- Pathogenic microorganisms were identified in 92 patients, with E. coli, Streptococcus spp., and Enterococci being most common.
- High resistance rates were observed for third-generation cephalosporins, penicillins with beta-lactamase inhibitors, and quinolones.
- Inadequate empirical treatment occurred in 30 patients, more frequently in those on immunosuppression (37% vs 10%), correlating with longer hospital stays.
Conclusions:
- Antimicrobial resistance profiles indicate a high rate of inadequate empirical first-line therapy for IAAs in CD.
- Inadequate treatment, especially in immunosuppressed patients, is linked to prolonged hospitalization.
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