Skuja Vita, Derovs Aleksejs, Pekarska Katrina, Rudzite Dace, Lavrinovica Elvira, Piekuse Linda, Kempa Inga, Straume Zane, Eglite Jelena, Lejnieks Aivars, Krumina Angelika, Eliakim Rami
Department of Internal Medicine.
Department of Gastroenterology, Hepatology and Nutrition, Gastroenterology, Hepatology and Nutrition Clinic.
Eur J Gastroenterol Hepatol. 2018 Jan;30(1):92-100. doi: 10.1097/MEG.0000000000000989.
Certain Enterobacteriaceae strains have been associated with the development of ulcerative colitis (UC). Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae are the most commonly found multi-drug-resistant (MDR) bacteria colonizing the gut in UC patients and might trigger a more severe disease activity in UC patients.
The aim of this study was to evaluate whether disease activity is higher in UC patients with gut colonization with ESBL-producing Enterobacteriaceae.
A cross-sectional, pilot study was carried out in a tertiary medical center in Latvia. Demographic data were collected; UC disease activity and extent were evaluated according to the full Mayo score, Montreal classification, and adapted Truelove and Witt's index. Rectal swabs with fecal biomaterial were collected, ESBL-producing Enterobacteriaceae were isolated, and bacterial plasmid genes responsible for ESBL production, blaCTX-M, blaTEM, and blaSHV, were detected. UC disease activity was compared in patients with and without gut colonization with ESBL-producing Enterobacteriaceae.
A total of 65 patients with UC were included in the initial analysis. Gut colonization with ESBL-producing Enterobacteriaceae was found in seven (11%) patients - mostly Escherichia coli [5 (71%)] containing the blaCTX-M bacterial plasmid gene. Patients with gut colonization with ESBL-producing Enterobacteriaceae had more severe disease compared with patients without gut colonization according to the full Mayo score (5.86 vs. 3.40; P=0.015), Montreal classification (moderate disease vs. clinical remission; P=0.031), and adapted Truelove and Witt's index (moderate disease vs. mild disease; P=0.008).
Gut colonization with ESBL-producing Enterobacteriaceae may increase UC disease activity. Further research is needed to analyze the possible confounding factors that could contribute toward this outcome.
某些肠杆菌科菌株与溃疡性结肠炎（UC）的发生有关。产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌是UC患者肠道中最常见的多药耐药（MDR）菌，可能会引发UC患者更严重的疾病活动。
本研究旨在评估产ESBL的肠杆菌科细菌肠道定植的UC患者疾病活动度是否更高。
在拉脱维亚的一家三级医疗中心开展了一项横断面试点研究。收集人口统计学数据；根据完整的梅奥评分、蒙特利尔分类和改良的特鲁洛夫和维茨指数评估UC疾病活动度和范围。采集含粪便生物材料的直肠拭子，分离出产ESBL的肠杆菌科细菌，并检测负责ESBL产生的细菌质粒基因blaCTX-M、blaTEM和blaSHV。比较产ESBL的肠杆菌科细菌肠道定植患者和未定植患者的UC疾病活动度。
初始分析共纳入65例UC患者。在7例（11%）患者中发现产ESBL的肠杆菌科细菌肠道定植——主要是大肠埃希菌[5例（71%）]，含有blaCTX-M细菌质粒基因。根据完整的梅奥评分（5.86对3.40；P=0.015）、蒙特利尔分类（中度疾病对临床缓解；P=0.031）和改良的特鲁洛夫和维茨指数（中度疾病对轻度疾病；P=0.008），产ESBL的肠杆菌科细菌肠道定植患者的疾病比未定植患者更严重。
产ESBL的肠杆菌科细菌肠道定植可能会增加UC疾病活动度。需要进一步研究分析可能导致这一结果的混杂因素。
