Extended spectrum beta-lactamase producing bacteria and Clostridium difficile in pouchitis patients

• Published in: Alimentary pharmacology & therapeutics 2010-07
• Main Authors: Mclaughlin, Simon D, Clark, Sue K, Roberts, Catherine H, Perry-Woodford, Zarah L, Tekkis, Paris, Ciclitira, Paul, Nicholls, R John
• Format: Article
• Language: English
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2010.04401.x

Background: Treatment with fluoroquinolones is associated with the development of Clostridium difficile and extended spectrum beta lactamase producing bacteria (ESBL). Clostridium difficile and ESBL are resistant to many antibiotics and each may cause pouchitis after restorative proctocolectomy (RPC) refractory to empirical antibiotic therapy. We assessed the prevelance of ESBL and Clostridium difficile in RPC patients with refractory or recurrent pouchitis. Method: An enzyme linked immunosorbent assay was used to detect Clostridium difficile toxins A and B (CDT) and a standard culture technique was used to identity ESBL in fresh faecal samples. All patients had previously received fluoroquinolone treatment. Results: 48 patients (35 (74%) males; median age 42 years) underwent CDT and ESBL testing at a median interval from RPC of 8 (range 1-25) years. No patient had a positive CDT result but the presence of ESBL bacteria was identified in 16 (33%) samples. ESBL positivity was significantly related to pre-pouch ileitis (p= 0.035) and maintenance antibiotic therapy (p= 0.039). Conclusion: ESBL but not CDT is a common finding in faecal samples from patients with recurrent or refractory pouchitis. Treatment with maintenance antibiotics and pre-pouch ileitis are risk factors for developing ESBL producing bacteria.