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P491. Epidemiology and clinical features of bloodstream infections in patients with inflammatory bowel disease

N. Inagaki1, R. Kunisaki2, T. Sasaki2, R. Koh2, H. Kimura2, R. Wu3, K. Yaguchi4, Y. Iizuka3, K. Kobayashi3, S. Yagi3, A. Ookawara5, E. Miyajima5, M. Ohba6, H. Ohge7,8, S. Maeda9, 1Yokohama City University Medical Centre, Inflammatory bowel disease centre, Yokohama, Japan, 2Yokohama City University Medical Centre, Inflammatory Bowel Disease Centre, Yokohama, Japan, 3Yokohama City University, School of Medicine, Yokohama, Japan, 4Yokohama Cit University, School of Medicine, Yokohama, Japan, 5Yokohama City University Medical Centre, Department of Laboratory Medicine and Clinical Investigation, Yokohama, Japan, 6Yokohama City University Medical Centre, Department of Biostatistics and Epidemiology, Graduate school of Medicine, Yokohama, Japan, 7Hiroshima University, Department of Surgery, Applied Life Sciences Institute of Biomedical & Health Sciences, Hiroshima, Japan, 8Hiroshima University, Department of Infectious Diseases, Hiroshima, Japan, 9Yokohama City University Graduate School of Medicine, Department of Gastroenterology, Yokohama, Japan

Background

With the advance in the medical therapy of patients with inflammatory bowel disease (IBD), patients with severe IBD have an increasing opportunity to receive multiple immunosuppressive therapy or surgical interventions. This has exposed IBD patients to an increased risk of blood stream infection (BSI), also known as septicaemia. Accordingly, recent studies have reported an increased incidence of opportunistic infection in IBD patients, but the epidemiology of BSI in IBD has not received adequate investigation.

Methods

Data were compiled by retrospective chart review of 1791 patients with IBD who had been treated at our university hospital between 2007 and 2012. Test samples from all patients with fever over 38 degree were taken through blood culture, and beta-D-glucan measurement. The diagnostic criteria for BSI were clinical signs of infection (fever, chills, and/or hypotension) and positive laboratory cultures from blood samples and/or catheters. The incidence of BSI, clinical features of patients with BSI, complication and the outcomes of BSI therapy were factored into our data review.

Results

Among 345 cases with blood culture data, 117 cases (33.9%) in 83 patients were found to have BSI. 74 patients (89.2%) were replaced central venous catheter (CVC). From these 117 BSI positive cases, 35 pathogens were isolated including 50 cases (42.7%) with methicillin-resistant Staphylococcus epidermidis (MRSE), 16 (13.7%) with methicillin-resistant Staphylococcus aureus (MRSA), 14 (12.0%) with methicillin-sensitive Staphylococcus aureus (MSSA), and 8 (6.8%) with enterococci spp. Further, 22 cases (18.8%) were positive for beta-D-glucan, and 10 (7.2%) were positive for the Candida species. No extended-spectrum beta-lactamase producing species were detected, MRSE infection was associated with Crohn's disease and corticosteroids therapy, MRSA infection was associated with ulcerative colitis and severe IBD, MSSA infection was associated with Crohn's disease and anti-tumour necrosis factor (TNF)-alfa therapy, enterococci infection was associated with Crohn's disease, corticosteroids and anti-TNF-alfa therapy, and Candida infection was associated with ulcerative colitis and thiopurine therapy. Regarding complications, septic embolism was found in 6 patients, but all cases fully recovered, and there was no death due to BSI.

Conclusion

The incidence of BSI in IBD patients was high, more than 30% of febrile patients were found to be with BSI. Although, hitherto bacterial translocation has been cited as a major source of infection in IBD patients, our data suggested that the colonization from the skin associated with catheters, in particular central venous catheters was the most common origin of BSI pathogens.