摘要
Background: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.Methods: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.Results:A total of 643(28%)had stool cultures done and only 1.7%(11/643)were found to be positive for stool cultures.Campylobacter spp.(45%)was the most common pathogen followed by Aeromonas 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(p<0.001 and p¼0.023).Patients with pathogenic bacteria were found to have a higher risk of acute kidney injury(27.3%vs 4.5%,p¼0.049),hospitalization within 3 months of initial stool testing(36.4%vs 6.8%,p¼0.009)and mortality(18.2%vs 0%,p¼0.040).However,there were no statistically significant differences in the clinical outcomes in patients with positive stool cultures who received pathogen-directed therapy.Conclusions: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.
背景:对于有症状的回肠储袋患者,临床上经常会进行粪便培养以明确肠道病原菌。本研究旨在探究常规粪便培养对于有症状的回肠储袋患者的评估价值,以及找到肠道病原菌对于这些患者的临床意义。方法:检索我们储袋数据库中2002-2015年间的2283例病例资料,筛选出其中有症状(提示储袋炎)且进行了粪便培养的病例纳入研究。将粪便培养结果阳性的患者作为研究组,并按1:4的比例进行匹配,选取粪便培养结果阴性的有症状患者作为对照。比较两组患者粪便培养1个月和3个月后的抗生素治疗反应、复发率和入院率。结果:共计643例(28%)患者出现储袋炎症状且进行了粪便培养,其中只有1.7%(11/643)的患者培养结果阳性。空肠弯曲杆菌(45%)是最常见的致病菌,其次是气单胞菌(36%)。不抽烟和近3个月未使用任何抗生素的患者,其培养结果阳性率更高(P<0.001和P¼0.023)。具有病原菌(培养结果阳性)的患者急性肾衰风险(27.3%vs.4.5%,P¼0.049)、3个月内住院率(36.4%vs.6.8%,P¼0.009)以及病死率(18.2%vs.0%,P¼0.040)均显著高于对照组。然而,对于培养结果阳性的患者,基于病原菌的针对性治疗后,其临床疗效与对照组相比并无显著改善。结论:我们发现对有症状的储袋患者进行粪便培养,其病原菌检出率极低,而且针对病原菌的治疗对储袋炎的疾病进程影响甚微。因此,对于这些患者是否有必要进行常规粪便培养需进一步研究。
