title: Extended spectrum beta-lactamase-producing bacteria and Clostridium difficile in patients with pouchitis.
abstract: BACKGROUND
  Treatment with fluoroquinolones is associated with the development of Clostridium difficile and extended spectrum beta-lactamase-producing bacteria (ESBL). Clostridium difficile and ESBL are resistant to many antibiotics and each may cause pouchitis after restorative proctocolectomy (RPC) refractory to empirical antibiotic therapy.
  
  
  OBJECTIVE
  To assess the prevalence and establish risk factors for the development of ESBL and Clostridium difficile toxins (CDT) in RPC patients with recurrent or refractory pouchitis under follow-up at our institution over a 1-year period.
  
  
  METHODS
  An enzyme-linked immunosorbent assay was used to detect CDT and a culture technique was used to identity ESBL in faecal samples. All patients had previously received fluoroquinolone treatment.
  
  
  RESULTS
  Forty-eight patients (35 (74%) men; median age 42 years) underwent testing at a median interval from RPC of 8 (range 1-25) years. No patient had a positive CDT result, but ESBL bacteria were identified in 16 (33%) samples. ESBL positivity was significantly related to prepouch ileitis (P = 0.035) and maintenance antibiotic therapy (P = 0.039).
  
  
  CONCLUSIONS
  Extended spectrum beta-lactamase, but not CDT, is a common finding in faecal samples from patients with recurrent or refractory pouchitis. Treatment with maintenance antibiotics and prepouch ileitis are risk factors for developing ESBL-producing bacteria.
authors.affiliation: Department of Gastroenterology, St Mark's Hospital, London, UK. simon.mclaughlin@nhs.net
authors.forename: S D
authors.initials: SD
authors.lastname: McLaughlin
authors.forename: S K
authors.initials: SK
authors.lastname: Clark
authors.forename: C H
authors.initials: CH
authors.lastname: Roberts
authors.forename: Z L
authors.initials: ZL
authors.lastname: Perry-Woodford
authors.forename: P P
authors.initials: PP
authors.lastname: Tekkis
authors.forename: P J
authors.initials: PJ
authors.lastname: Ciclitira
authors.forename: R J
authors.initials: RJ
authors.lastname: Nicholls
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000302:isolation & purification; D003015:Clostridium Infections / Q000382:microbiology*; D004351:Drug Resistance; D004755:Enterobacteriaceae / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000382:microbiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D019449:Pouchitis / Q000382:microbiology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012307:Risk Factors; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases