Inflammatory Bowel Disease Activity in Previously Hospitalised Patients with Extended Spectrum Beta-lactamase Producing Enterobacteriaceae Presence in the Gut. Summary of the Doctoral Thesis

Abstract

Background. Extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae (ESBL-E) are the most commonly found multi-drug resistant bacteria in the gut of inflammatory bowel disease (IBD) patients. Previously hospitalized IBD patients are more likely to repeatedly come into contact with the medical system and promote further spread of ESBL-E if they are found in the patient’s gut. Considering that increased proportion of Enterobacteriaceae in the gut microbiota is associated with the development of IBD – ulcerative colitis (UC) and Crohn’s disease (CD), a higher IBD clinical disease activity could be observed in case of ESBL-E presence in the gut. Aim and objectives. The aim of the study was to determine the differences in IBD clinical disease activity in previously hospitalized UC and CD patients with and without ESBLE presence in their gut. The study is based on the hypothesis that higher clinical disease activity is observed in previously hospitalized IBD patients with ESBL-E in their gut. Materials and methods. A cross-sectional study was carried out in two tertiary medical centers in Riga, Latvia betrween 2015 and 2017. Thes study incluced information on IBD clinical disease activity in previously hospitalized UC and CD patients and information about presence of ESBL-E in their gut. UC and CD pacients were analysed seperately, beacuse of the differences in the principles of determening the clinical disease activity and differences in the clinical scores between the two diseases. UC clincial disease activity and extent was evaluated according to the full and partial Mayo score, adapted Truelove and Witt’s index and Montreal classification and CD clinical disease activity and extent was evaluated according to Crohn’s disease activity index (CDAI), Harvey-Bradshaw index (HBI) and Montreal classification, according to the European Crohn’s and Colitis Oraganisation (ECCO) guidelines. Rectal swabs with fecal biomaterial were collected from the patients, ESBL-E were isolated, and bacterial plasmid genes responsible for ESBL production (blaCTX-M, blaTEM and blaSHV) were detected, according to the European Committee on Antibicrobial Susceptibility Testing (EUCAST) guidelines. Clinical disease activity in previously hospitalised UC and CD patients was compared in cases with and without ESBL-E presence in patient’s gut. Results. A total of 177 previously hospitalised IBD patients – 122 (69%) UC and 55 (31%) CD patients were analysed in the study. ESBL-E presence in previously hospitalised IBD patient’s gut was found in 19 (11%) cases – 13 (11%) UC and 6 (11%) CD cases. E. coli, was the most frequently found ESBL producing strain, most frequently containing blaCTX-M bacterial plasmid gene in both previously hospitalised UC and CD patients. Previoulsy hospitalised UC and CD patients with ESBL-E presence in their gut had more severe IBD clinical disease activity compared to patients without ESBL-E presence in their gut, according to full Mayo score (Mdn = 5, IQR = 6 vs. Mdn = 3, IQR = 2 points; p = 0.016), adapted Truelove and Witt’s index (moderate vs. mild disease; p < 0.0001) and Montreal classification (moderate disease vs. clinical remission; p = 0.001) in UC patients and CDAI (moderate disease vs. remission; p = 0.028; Mdn = 219, IQR = 281.71 vs. Mdn = 103.99, IQR = 119.01 points; p = 0.023) and HBI (moderate disease vs. remission; p = 0.008; Mdn = 7, IQR = 8 vs. Mdn = 3, IQR = 5 points; p = 0.01) in CD patients. Previously hospitalised UC patients with ESBL-E presence in their gut, comparing to patients without ESBL-E presence in their gut had more extensive disease according to the Montreal classification (extensive (E3) vs. protctitis (E1); p = 0.042). Conclusions. Higher IBD clinical disease activity was observed in previously hospitalised UC and CD patients with ESBL-E presence in their gut. Further studies are needed to examine the association between ESBL-E presence in the gut and IBD activity.