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P783 Ciprofloxacin resistance in ESBL producing enterobacteriaceae colonizing the gut in IBD patients

Skuja V.*1,2, Pekarska K.3, Straume Z.2,4, Rudzīte D.5, Lavrinoviča E.5, Piekuse L.6, Dauvarte H.3, Vašuka E.1,7, Dobelniece L.1,7, Zalizko P.4,8, Derovs A.2,9, Krūmiņa A.10,11, Lejnieks A.1,7

1Riga Stradins University, Department of Internal Medicine, Riga, Latvia 2Riga East Clinical University Hospital, Gastroenterology, Hepatology and Nutrition Clinic, Riga, Latvia 3Riga Stradins University, Faculty of Medicine, Riga, Latvia 4University of Latvia, Department of Gastroenterology, Riga, Latvia 5Riga East Clinical University Hospital, Laboratory Medicine Centre, Department of Microbiology, Riga, Latvia 6Riga Stradins University, Scientific Laboratory of Molecular Genetics, Riga, Latvia 7Riga East Clinical University Hospital, Department of Internal Medicine, Riga, Latvia 8Pauls Stradins Clinical University Hospital, Department of Gastroenterology, Hepatology and Nutrition, Riga, Latvia 9Riga Stradins University, Department of Gastroenterology, Riga, Latvia 10Riga Stradins University, Department of Infectious diseases, Riga, Latvia 11Riga East Clinical University Hospital, Department of Infectious Diseases, Riga, Latvia

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.

Conclusion

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.