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J Crohns Colitis. 2018 May 25;12(6):695-701. doi: 10.1093/ecco-jcc/jjy017.

Microbial Spectrum of Intra-Abdominal Abscesses in Perforating Crohn's Disease: Results from a Prospective German Registry.

Author information

1
Department of Internal Medicine IV [Gastroenterology, Hepatology, and Infectious Diseases], Jena University Hospital, Jena, Germany.
2
Klinik für Gastroenterologie, Pulmonologie und Allgemeine Innere Medizin, Evangelisches Krankenhaus Köln Kalk, University of Cologne, Cologne, Germany.
3
Ambulanzzentrum Gastroenterologie, University Teaching Hospital Lüneburg, Lüneburg, Germany.
4
Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten Leipzig und Schkeuditz, Leipzig, Germany.
5
Medical Faculty, Friedrich-Schiller University, Jena, Germany.
6
Department of Internal Medicine I [Gastroenterology], University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
7
Department of Medicine I [Gastroenterology, Infectious Diseases, Rheumatology], Charité-Universitätsmedizin Berlin, Berlin, Germany.
8
Department of Internal Medicine 1, University Hospital Carl Gustav Carus, Dresden, Germany.
9
Department of Surgery, University Medical Center Regensburg, Regensburg, Germany.

Abstract

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.

PMID:
29415186
DOI:
10.1093/ecco-jcc/jjy017
[Indexed for MEDLINE]

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