Singh Amandeep, Ashburn Jean, Kochhar Gursimran, Lopez Rocio, Hull Tracy L, Shen Bo
Department of Gastroenterology & Hepatology, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA.
Department of Colorectal Surgery, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA.
Gastroenterol Rep (Oxf). 2018 May;6(2):93-100. doi: 10.1093/gastro/gox037. Epub 2017 Nov 24.
In symptomatic patients with an ileal pouch, stool studies are often sent to diagnose enteric pathogens. Aim of this study is to find the value of routine stool studies in the evaluation of symptomatic patients and the clinical implications of such pathogens in patients with ileal pouches.
Consecutive ileal pouch-anal anastomosis (IPAA) patients who had stool tests out of a 2283-case registry from 2002 to 2015 were included in the study. Patients with positive stool cultures were compared with controls (symptomatic without positive stool culture) in a 1:4 ratio. Response to antibiotic therapy, recurrence rate and rate of hospitalization at 1 and 3 months were assessed.
A total of 643 (28%) had stool cultures done and only 1.7% (11/643) were found to be positive for stool cultures. spp. (45%) was the most common pathogen followed by spp. (36%). Non-smokers and patients without any antibiotic use in the last 3 months were found to have higher prevalence of positive stool cultures than controls ( < 0.001 and = 0.023). Patients with pathogenic bacteria were found to have a higher risk of acute kidney injury (27.3% vs 4.5%, = 0.049), hospitalization within 3 months of initial stool testing (36.4% vs 6.8%, = 0.009) and mortality (18.2% vs 0%, = 0.040). However, there were no statistically significant differences in the clinical outcomes in patients with positive stool cultures who received pathogen-directed therapy.
We found that the yield of stool tests for bacterial pathogens in symptomatic pouch patients was extremely low and the treatment of detected pathogens had a minimum impact on the disease course of pouchitis. The clinical utility of routine stool culture in those patients warrants further study.
对于有回肠储袋的有症状患者，通常会进行粪便检查以诊断肠道病原体。本研究的目的是探讨常规粪便检查在评估有症状患者中的价值以及此类病原体在回肠储袋患者中的临床意义。
纳入2002年至2015年2283例登记病例中进行粪便检测的连续性回肠储袋肛管吻合术（IPAA）患者。粪便培养阳性的患者与对照组（有症状但粪便培养阴性）按1:4的比例进行比较。评估抗生素治疗反应、复发率以及1个月和3个月时的住院率。
共有643例（28%）患者进行了粪便培养，其中仅1.7%（11/643）粪便培养呈阳性。 菌属（45%）是最常见的病原体，其次是 菌属（36%）。发现非吸烟者和过去3个月内未使用任何抗生素的患者粪便培养阳性率高于对照组（ <0.001和 =0.023）。发现有病原菌的患者发生急性肾损伤的风险更高（27.3%对4.5%， =0.049），在首次粪便检测后3个月内住院的风险更高（36.4%对6.8%， =0.009），死亡率也更高（18.2%对0%， =0.040）。然而，接受针对病原体治疗的粪便培养阳性患者的临床结局无统计学显著差异。
我们发现，有症状储袋患者粪便检测中细菌病原体的检出率极低，检测到的病原体治疗对袋炎病程的影响最小。常规粪便培养在这些患者中的临床实用性值得进一步研究。
