title: Perianal fistulas in Crohn's disease are predominantly colonized by skin flora: implications for antibiotic treatment?
abstract: In this study we aimed to determine the microorganisms found in perianal fistulas in Crohn's disease and whether treatment with ciprofloxacin affects these microorganisms. Thirteen patients (males/females, 7/6; median age, 34 years; range, 18-61 years) with fistulas were treated with infliximab, 5 mg/kg intravenously, at weeks 6, 8, and 12 and randomized to double-blind treatment with ciprofloxacin, 500 mg bd (n = 6), or placebo (n = 7) for 12 weeks. Samples were taken at baseline and at weeks 6 and 18. In the ciprofloxacin group 10 different genera of microorganisms were identified, while 13 genera could be identified in the placebo group. Gram-negative enteric floras were present in a small minority. The genera found in patients with perianal fistulas were predominantly gram-positive microorganisms. Therefore, antimicrobial treatment should be directed toward these microorganisms.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC/University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: R L
authors.initials: RL
authors.lastname: West
authors.forename: C J
authors.initials: CJ
authors.lastname: Van der Woude
authors.forename: H Ph
authors.initials: HP
authors.lastname: Endtz
authors.forename: B E
authors.initials: BE
authors.lastname: Hansen
authors.forename: M
authors.initials: M
authors.lastname: Ouwedijk
authors.forename: H A M
authors.initials: HA
authors.lastname: Boelens
authors.forename: J G
authors.initials: JG
authors.lastname: Kusters
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuipers
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D003354:Corynebacterium Infections / Q000188:drug therapy; D003424:Crohn Disease / Q000150:complications*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000209:etiology* / Q000382:microbiology*; D012867:Skin / Q000382:microbiology*
chemical_list: D000890:Anti-Infective Agents; D002939:Ciprofloxacin