Background: Ciprofloxacin is one of the most frequently used antibiotics in hospitalized inflammatory bowel disease (IBD) patients. In the last few years an emerging resistance to ciprofloxacin, ranging from 43% to 82%, has been described in extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae colonizing the gut (Lübbert, Christoph et al. 2015; Vervoort, J. et al. 2014). The objective of this study was to evaluate the gut colonization with ESBL producing Enterobacteriaceae in IBD patients, resistance to ciprofloxacin and bacterial plasmid genes determining the resistance to ciprofloxacin.
Methods: Rectal swabs were collected from all consecutive patients hospitalized in Riga East Clinical University Hospital and Pauls Stradins Clinical University Hospital between 2012 and 2015 with clinically, endoscopically and histologically confirmed ulcerative colitis (UC) and Crohn's disease (CD) diagnoses. Enterobacteriaceae were cultured and analyzed for ESBL presence according to EUCAST guidelines, resistance to ciprofloxacin and bacterial plasmid genes – CTX-M, TEM and SHV were detected.
Results: A total of 130 patients with confirmed IBD diagnosis were included in the study – 92 (71%) with UC, 38 (29%) with CD. We found that 11 (12%) of the UC patients and 3 (8%) of the CD patients were colonized with ESBL producing Enterobacteriaceae. The isolated ESBL producing Enterobacteriaceae strains from UC patients included Escherichia coli (n=9), Klebsiella oxytoca (n=1) and Escherichia hermanii (n=1). The isolated ESBL producing Enterobacteriaceae from CD patients included Escherichia coli (n=3). The isolated bacterial plasmid genes associated with ESBL production in UC included CTX-M (n=11), TEM (n=4), SHV (n=2), in CD – TEM (n=3) and CTX-M (n=2). In UC 5 (46%) and in CD 1 (33%) of the isolated ESBL producing Enterobacteriaceae were resistent to ciprofloxacin. In 1 case of ESBL resistance to ciprofloxacin CTX-M, TEM and SHV gene combination was observed, in 2 cases CTX-M and TEM gene combination was observed and in 3 cases only CTX-M gene was present.
Conclusions: 1. High gut colonization rate (12%) with ESBL producing bacteria in UC patients, mostly E. coli, expressing CTX-M gene comparing with the literature. 2. High resistance to ciprofloxacin (46%) in UC patients, comparing to CD patients. 3. CTX-M gene associated with resistance to ciprofloxacin.