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Ciprofloxacin Usage and Bacterial Resistance Patterns in Crohns Disease Patients With Abscesses

Park, Soo-Kyung MD*; Kim, Kyung-Jo MD*; Lee, Sang-Oh MD; Yang, Dong-Hoon MD*; Jung, Kee Wook MD*; Ye, Byong Duk MD*; Byeon, Jeong-Sik MD*; Myung, Seung-Jae MD*; Yang, Suk-Kyun MD*; Kim, Jin-Ho MD*; Yu, Chang Sik MD

Journal of Clinical Gastroenterology:
doi: 10.1097/MCG.0000000000000024
ALIMENTARY TRACT: Original Articles
Abstract

Background: Ciprofloxacin is the antibiotic most frequently used in the treatment of Crohn’s disease (CD). We attempted to identify the microorganisms present in CD-related intra-abdominal abscesses, their ciprofloxacin resistance patterns, and the clinical impact.

Methods: Microorganisms, their ciprofloxacin resistance, and clinical outcomes were retrospectively analyzed in 78 CD patients with intra-abdominal abscesses, who underwent percutaneous drainage between March 1991, and November 2011.

Results: The median time from diagnosis of CD to abscess drainage was 59.5 months (range, 1 to 178 mo). As for bacteriology, the no-growth proportion was 38.5% (n=30), and 69 microorganisms belonging to 11 genera were isolated from the other 48 (61.5%) patients. Of the 69 microorganisms, 65 were bacteria, including 30 (43.4%) gram-positive, 28 (40.6%) gram-negative aerobes, 7 (10.1%) gram-negative anaerobes, and 4 (4.1%) fungi. Streptococci spp. (25, 36.2%) were the most common bacteria, followed by Escherichia coli (18, 26.1%). Nineteen of the 28 gram-negative aerobes (67.9%) were resistant to ciprofloxacin, including 14 of 18 (77.8%) E. coli isolates. When we compared clinical characteristics and treatment outcomes in 17 patients with ciprofloxacin-resistant and 8 with ciprofloxacin-sensitive bacteria, we found that disease duration from diagnosis to drainage (97.2 vs. 50.7 mo, P=0.03) and median length of hospitalization (40 vs. 31 d, P=0.03) was significantly longer in the former.

Conclusions: When gram-negative aerobes were isolated from abscesses in CD patients, more than two thirds were resistant to ciprofloxacin. Providers should consider this high rate of ciprofloxacin resistance when choosing first-line antibiotic treatment for CD-related intra-abdominal abscesses.

Author Information

Departments of *Gastroenterology

Infectious Disease

Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

The authors declare that they have nothing to disclose.

Reprints: Kyung-Jo Kim, MD, Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center 88, Olympic-ro 43-gil Songpa-gu, Seoul 138-736, Korea (e-mail: capsulendos@gmail.com).

Received May 8, 2013

Accepted October 8, 2013

© 2014 by Lippincott Williams & Wilkins