title: Prevalence and predictors of MRSA, ESBL, and VRE colonization in the ambulatory IBD population.
abstract: OBJECTIVE
  Inflammatory bowel disease (IBD) patients may be at increased risk of acquiring antibiotic-resistant organisms (ARO). We sought to determine the prevalence of colonization of methicillin-resistant Staphylococcus aureus (MRSA), Enterobacteriaceae containing extended spectrum beta-lactamases (ESBL), and vancomycin-resistant enterococi (VRE) among ambulatory IBD patients.
  
  
  METHODS
  We recruited consecutive IBD patients from clinics (n=306) and 3 groups of non-IBD controls from our colon cancer screening program (n=67), the family medicine clinic (n=190); and the emergency department (n=428) from the same medical center in Toronto. We obtained nasal and rectal swabs for MRSA, ESBL, and VRE and ascertained risk factors for colonization.
  
  
  RESULTS
  Compared to non-IBD controls, IBD patients had similar prevalence of colonization with MRSA (1.5% vs. 1.6%), VRE (0% vs. 0%), and ESBL (9.0 vs. 11.1%). Antibiotic use in the prior 3 months was a risk factor for MRSA (OR, 3.07; 95% CI: 1.10-8.54), particularly metronidazole. Moreover, gastric acid suppression was associated with increased risk of MRSA colonization (adjusted OR, 7.12; 95% CI: 1.07-47.4). Predictive risk factors for ESBL included hospitalization in the past 12 months (OR, 2.04, 95% CI: 1.05-3.95); treatment with antibiotics it the past 3 months (OR, 2.66; 95% CI: 1.37-5.18), particularly prior treatment with vancomycin or cephalosporins.
  
  
  CONCLUSIONS
  Ambulatory IBD patients have similar prevalence of MRSA, ESBL and VRE compared to non-IBD controls. This finding suggests that the increased MRSA and VRE prevalence observed in hospitalized IBD patients is acquired in-hospital rather than in the outpatient setting.
authors.affiliation: Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, ON, Canada.
authors.forename: Wesley
authors.initials: W
authors.lastname: Leung
authors.forename: Gurtej
authors.initials: G
authors.lastname: Malhi
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Willey
authors.forename: Allison J
authors.initials: AJ
authors.lastname: McGeer
authors.forename: Bjug
authors.initials: B
authors.lastname: Borgundvaag
authors.forename: Reka
authors.initials: R
authors.lastname: Thanabalan
authors.forename: Piraveina
authors.initials: P
authors.lastname: Gnanasuntharam
authors.forename: Brian
authors.initials: B
authors.lastname: Le
authors.forename: Adam V
authors.initials: AV
authors.lastname: Weizman
authors.forename: Kenneth
authors.initials: K
authors.lastname: Croitoru
authors.forename: Mark S
authors.initials: MS
authors.lastname: Silverberg
authors.forename: A Hillary
authors.initials: AH
authors.lastname: Steinhart
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000494:pharmacology; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology*; D002511:Cephalosporins / Q000627:therapeutic use; D004755:Enterobacteriaceae / Q000201:enzymology; D004756:Enterobacteriaceae Infections / Q000453:epidemiology; D016983:Enterococcus / Q000187:drug effects; D005260:Female; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000382:microbiology*; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009666:Nose / Q000382:microbiology; D015995:Prevalence; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012007:Rectum / Q000382:microbiology; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology; D014640:Vancomycin / Q000494:pharmacology / Q000627:therapeutic use; D020713:Vancomycin Resistance; D055815:Young Adult; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D014640:Vancomycin; D001618:beta-Lactamases