IBD Patients Have More Severe Aeromonas Infections

Patients with inflammatory bowel disease (IBD) more likely face more severe symptom presentation following Aeromonas infections.

A team, led by Pereira T. Guedes, Gastroenterology Department, Centro Hospitalar Universitário do Porto, examined the significance of Aeromonas infections between patients with IBD and patients without IBD.

The Diseases

Aeromonas are gram-negative rods that can cause a number of different diseases, including diarrheal disease, wound infections, and gastroenteritis, but it is largely unknown whether or not IBD is 1 of them.

In the retrospective, observational analysis, the investigators identified all patients positive for Aeromonas in stool cultures during a 10-year period from a tertiary and university hospital.

Overall, they identified 50 patients with a mean age of 42.1 years. Of this group, 76% (n = 38) were non-IBD and 24% (n = 12) of the patients had IBD.

Patients with IBD were more frequently under immunosuppressors. For severity, 2 patients were asymptomatic, 44% developed mild infections, 44% had moderate disease, and 16.7% had severe infections.

Main Strains and Symptom Presentation

The investigators isolated the main strains, which were Aeromonas hydrophila and caviae and bacterial co-isolation was found in 4 non-IBD patients and histological findings of cytomegalovirus was found in 2 patients with IBD.

There were some trends found in how symptoms presented in IBD compared to non-IBD.

For example, patients who did not have IBD presented with fever more frequently, while on the other side, patients with IBD more likely had bloody diarrhea and abdominal pain.

There were also more severe infections in the patients with IBD group with higher antimicrobial therapy used. In addition, steroid use was exclusively used in patients with IBD.

There were 4 patients with ulcerative colitis and 9 patients with Crohn’s disease with colonic involvement, 5 of which received an IBD diagnosis after the cute episode of Aeromonas infection.

“Clinical presentation of Aeromonas infection differs between IBD and non-IBD patients,” the authors wrote. “Non-IBD patients had milder severity of infection with less use of antibiotics. Aeromonas infection seems to greatly contribute to IBD manifestation.”

IBD and C Difficile Infections

Recently, investigators found pediatric patients with inflammatory bowel disease patients are at an elevated risk for developing Clostridioides difficile infections (CDI), which could lead to treatment escalation later in life.

A team, led by Wael El-Matary, MD, University of Manitoba, Department of Pediatric Gastroenterology, investigated the incidence and risk factors associated with CDI in pediatric patients with IBD in Manitoba, Canada.

For patients with ulcerative colitis, the incidence rate of CDI was 4.16 cases per 1000 person-years, while the incidence rate was 5.88 cases per 1000 person-years in patients with Crohn’s disease (P = 0.46).

Overall, pediatric patients with CDI were at an increased risk of future exposure to systemic corticosteroids (HR, 4.30; 95% CI, 1.44-12.87) and anti-tumor necrosis factor (TNF) biologics (HR, 3.37; 95% CI, 1.13–10.09)when compared to individuals without CDI.

The overall recurrence rate of CDI in the pediatric IBD population was 25%.

The study, “Positioning Aeromonas Infection in Inflammatory Bowel Disease: A Retrospective Analysis,” was published online in the Portuguese Journal of Gastroenterology.