title: Ciprofloxacin usage and bacterial resistance patterns in Crohn's disease patients with abscesses.
abstract: BACKGROUND
  Ciprofloxacin is the antibiotic most frequently used in the treatment of Crohn's disease (CD). We attempted to identify the microorganisms present in CD-related intra-abdominal abscesses, their ciprofloxacin resistance patterns, and the clinical impact.
  
  
  METHODS
  Microorganisms, their ciprofloxacin resistance, and clinical outcomes were retrospectively analyzed in 78 CD patients with intra-abdominal abscesses, who underwent percutaneous drainage between March 1991, and November 2011.
  
  
  RESULTS
  The median time from diagnosis of CD to abscess drainage was 59.5 months (range, 1 to 178 mo). As for bacteriology, the no-growth proportion was 38.5% (n=30), and 69 microorganisms belonging to 11 genera were isolated from the other 48 (61.5%) patients. Of the 69 microorganisms, 65 were bacteria, including 30 (43.4%) gram-positive, 28 (40.6%) gram-negative aerobes, 7 (10.1%) gram-negative anaerobes, and 4 (4.1%) fungi. Streptococci spp. (25, 36.2%) were the most common bacteria, followed by Escherichia coli (18, 26.1%). Nineteen of the 28 gram-negative aerobes (67.9%) were resistant to ciprofloxacin, including 14 of 18 (77.8%) E. coli isolates. When we compared clinical characteristics and treatment outcomes in 17 patients with ciprofloxacin-resistant and 8 with ciprofloxacin-sensitive bacteria, we found that disease duration from diagnosis to drainage (97.2 vs. 50.7 mo, P=0.03) and median length of hospitalization (40 vs. 31 d, P=0.03) was significantly longer in the former.
  
  
  CONCLUSIONS
  When gram-negative aerobes were isolated from abscesses in CD patients, more than two thirds were resistant to ciprofloxacin. Providers should consider this high rate of ciprofloxacin resistance when choosing first-line antibiotic treatment for CD-related intra-abdominal abscesses.
authors.affiliation: Departments of *Gastroenterology †Infectious Disease ‡Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Soo-Kyung
authors.initials: SK
authors.lastname: Park
authors.forename: Kyung-Jo
authors.initials: KJ
authors.lastname: Kim
authors.forename: Sang-Oh
authors.initials: SO
authors.lastname: Lee
authors.forename: Dong-Hoon
authors.initials: DH
authors.lastname: Yang
authors.forename: Kee Wook
authors.initials: KW
authors.lastname: Jung
authors.forename: Byong
authors.initials: B
authors.lastname: Duk Ye
authors.forename: Jeong-Sik
authors.initials: JS
authors.lastname: Byeon
authors.forename: Seung-Jae
authors.initials: SJ
authors.lastname: Myung
authors.forename: Suk-Kyun
authors.initials: SK
authors.lastname: Yang
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Kim
authors.forename: Chang
authors.initials: C
authors.lastname: Sik Yu
mesh_terms: D018784:Abdominal Abscess / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000494:pharmacology / Q000627:therapeutic use*; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy; D004322:Drainage / Q000379:methods; D024881:Drug Resistance, Bacterial; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin