Enteric Infection in Relapse of Inflammatory Bowel Disease: The Utility of Stool Microbial PCR Testing
Enteric Infection in Relapse of Inflammatory Bowel Disease: The Utility of Stool Microbial PCR Testing
复制标题
DOI：
10.1097/mib.0000000000001097
复制
发表时间：
2017-06-01
影响因子：
4.9
通讯作者：
Lebwohl, Benjamin
中科院分区：
文献类型：
--
作者：
Axelrad, Jordan E.;Joelson, Andrew;Lebwohl, Benjamin
背景资料：炎症性肠病（IBD）和肠道感染复发的相似表现给诊断和治疗带来了实质性障碍。本研究的目的是调查肠道感染的发病率，病因，预测因素和治疗IBD患者。方法：我们回顾了214例IBD患者的记录进行了295胃肠道病原体面板和艰难梭菌感染（CDI）聚合酶链反应（PCR）粪便试验期间症状加重。我们收集了基线特征、PCR结果和药物暴露。我们通过卡方检验和t检验来检验关联性。结果：在295例患者中，CDI阳性38例（12.9%），其他14种病原体阳性41例（13.8%），其中大肠埃希氏菌（E.大肠杆菌是最常见的。CDI或IBD结肠受累的既往病史可预测CDI，而既往结肠切除术可预测CDI阴性。大多数CDI患者（24例，63.2%）接受口服万古霉素治疗，15例（37.5%）接受其他肠道病原体治疗。CDI患者的中位住院时间较长（8.5 vs 4天，P = 0.041）。肠道感染检测阴性的患者更有可能增加或上调IBD药物剂量（P = 0.027）。结论：在79例（26.8%）有症状的IBD患者中检测到肠道感染，以CDI最常见，其次是E。杆菌粪便PCR检测阴性与IBD管理的变化相关。IBD复发期间应考虑进行广泛的肠道PCR检测。
Background: The similar presentations in relapse of inflammatory bowel disease (IBD) and enteric infection pose substantial barriers to diagnosis and treatment. The objective of this study was to investigate the incidence, etiology, predictors, and treatment of enteric infection in patients with IBD.Methods: We reviewed the records of 214 patients with IBD who underwent 295 gastrointestinal pathogen panel and Clostridium difficile infection (CDI) polymerase chain reaction (PCR) stool tests during an exacerbation of symptoms. We collected baseline characteristics, PCR outcomes, and medication exposures. We tested for associations via the Chi-square test and the t-test. Logistic regression analysis was used to identify predictors of enteric infection.Results: Of 295 PCR tests ordered during an exacerbation of symptoms, 38 (12.9%) were positive for CDI and 41 (13.8%) were positive for 14 other pathogens, with E. coli species as the most common. A previous history of CDI or colonic involvement of IBD predicted CDI, whereas a previous colectomy predicted negative testing for CDI. The majority with CDI (24, 63.2%) received oral vancomycin and 15 (37.5%) with other enteric pathogens were treated for their infection. Patients with CDI had a longer median length of hospital stay (8.5 versus 4 days, P = 0.041). Patients who tested negative for enteric infections were more likely to have IBD medications added or up-titrated (P = 0.027).Conclusions: Enteric infection was detected in 79 (26.8%) symptomatic patients with IBD, with CDI the most frequent followed by E. coli. Negative stool PCR testing was associated with changes in IBD management. Broad enteric PCR testing should be considered during relapse of IBD.