Fecal coliform testing to identify effective antibiotic therapies for patients with antibiotic-resistant pouchitis.
OBJECTIVE
Empiric antibiotic therapy (eg, a combination of ciprofloxacin and metronidazole) is effective in treating the majority of patients with inflammation of the ileal reservoir (pouchitis). Unfortunately, up to 20% of patients develop refractory or rapidly relapsing disease. We developed a fecal sensitivity analysis to determine which antibiotics are most likely to be effective in patients who do not respond to empiric antibiotic therapy or have relapsed after long-term therapy.


METHODS
Fecal samples from 15 patients with active pouchitis (pouch disease activity index [PDAI], > or =7) who failed standard antibiotic treatment were inoculated onto Iso-sensitest agar. Antibiotic testing discs were added, incubated, and sensitivity patterns were recorded. Patients then were treated with antibiotics based on predicted sensitivity; PDAI scores were assessed 4 weeks later. Thirteen patients enrolled in the study had failed to enter remission after treatment with ciprofloxacin and metronidazole and 2 patients had relapsed after maintenance treatment with ciprofloxacin.


RESULTS
Antibiotic coliform sensitivity testing showed ciprofloxacin resistance in all samples, co-amoxiclav resistance in 4 samples, trimethoprim resistance in 11 samples, and cefixime resistance in 8 samples. All 15 patients were treated with an antibiotic to which their fecal coliforms were sensitive; 12 (80%) achieved clinical remission (PDAI score, 0).


CONCLUSIONS
Fecal coliform sensitivity analysis can identify effective antibiotic therapies for patients with antibiotic-resistant pouchitis. This targeted antibiotic approach is recommended in all patients who fail to respond to empiric antibiotic treatment or relapse after long-term antibiotic therapy.
Department of Biosurgery and Surgical Technology, Imperial College, London, United Kingdom. simon.mclaughlin@nhs.net
Simon D
SD
McLaughlin
Susan K
SK
Clark
Suja
S
Shafi
Liljana
L
Petrovska
Liljana
L
Petrovksa
Paris P
PP
Tekkis
Paul J
PJ
Ciclitira
R John
RJ
Nicholls
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification*; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D008875:Middle Aged; D019449:Pouchitis / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents