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Poster presentations: Clinical: Therapy and Observation 2020

P569 The role of multidrug-resistant infections in IBD patients undergoing surgery

F. Colombo1, G.M.B. Lamperti1, S. Antinori2, M. Corbellino2, G. Maconi3, S. Ardizzone3, D. Foschi1, G. Sampietro1

1L.Sacco University Hospital, General Surgery, Milan, Italy, 2L.Sacco University Hospital, Infectious Diseases Department, Milan, Italy, 3L.Sacco University Hospital, Gastroenterology Unit, Milan, Italy

Background

Inflammatory bowel diseases (IBD) patients are particularly vulnerable to an increased incidence of infections, due to both innate characteristics and prolonged pharmacological therapies as steroids, biologics and antibiotics. Very few data are available in the literature about multidrug-resistant (MDR) infections and previous studies have not taken into account the impact of the surgical treatment on infections. We focused on the identification of risk factors for the development of MDR infections in IBD patients undergoing surgical procedures, we investigated the involved microorganisms, and finally, we proceeded to a costs/complications analysis of the treatment.

Methods

472 consecutive, unselected IBD patients (285 Crohn’s disease and 187 ulcerative colitis) undergoing surgery from 2016 to 2018 in our Tertiary Care Centre were divided into three groups: MDR infections, antibiotics sensitive infections (no-MDR) and no infections.

Results

In 37 CD patients nutritional status (p < 0.0008), preoperative biologics (p < 0.008) and antibiotic therapy (p < 0.001), duration of surgical procedure (p < 0.0001) and preoperative hospitalisation length (p < 0.0001) were risks factors for MDR infection development. In 14 UC patients multidrug-resistant infection was related to age at surgery (p < 0.003), disease duration (p < 0.008), inflammatory/nutritional status (p < 0.04), preoperative antibiotic therapy (p < 0.04), and suture leakage (p < 0,01). In the MDR CD group Gram + cocci (54%) were the most implicated pathogens, with a prevalence of 19% of Enterococcus faecium; while in MDR UC patients Gram – bacilli (59%) were the most involved pathogens, with prevalence of Escherichia coli ESBL+ (47%). The antibiotic therapy cost for the CD group was higher in MDR (3249 €) and no-MDR (924 €) groups vs. non-infected patients (41€). In UC we found higher cost only in the MDR group (1408€ vs. 33€).

Conclusion

Preoperative risk factors involved in the development of MDR infections in IBD patients undergoing surgery were identified. Some factors, such as nutritional status or preoperative antibiotic therapy, were found to be common between CD and UC patients, while some others were found to be specific for UC or CD. Some of these elements appear to be non-modifiable, while some others are part of the multidisciplinary approach, for which further studies are needed to improve the preoperative ‘patient optimisation’ in order to reduce surgical complications.