Explore the vast range of titles available.

BACKGROUND:Patients with IBD report increased gastrointestinal symptoms, including diarrhea, abdominal pain, and nausea following COVID-19 diagnosis. While there has been a great amount of research assessing outcomes of COVID-19 in patients with IBD, little is known about the effects of COVID-19 on IBD disease activity. We aimed to explore IBD related outcomes in a cohort of IBD patients affected by COVID-19.METHODS:We performed a retrospective case series of patients with IBD who were diagnosed with COVID-19 and seen in a single tertiary care referral center from March 2020 to March 2021 after IRB approval. We compared patients who were in stable remission up to 90 days prior to the COVID-19 diagnosis to those who were not in remission during the same time frame. COVID-19 diagnosis was made based on a combination of symptoms and positive rapid antigen and/or PCR test. Disease activity was estimated based on routinely measured clinical disease severity indices documented in office visit notes, including partial Mayo score for ulcerative colitis (UC) or Harvey-Bradshaw Index for Crohn's disease (CD) and/or endoscopic scoring documented in procedure notes including Mayo endoscopic subscore for UC or simple endoscopic score for CD documented in the procedure notes. For the primary outcome, we assessed IBD related outcomes by determining the need for escalation of immunosuppressive maintenance therapy, and/or need for IBD related hospitalization/surgery within 3 months after diagnosis of COVID-19. For the secondary outcome, COVID-19 related outcomes were assessed including need for hospitalization, ICU stay, use of COVID-19 related therapy such as monoclonal antibodies, and death. Continuous variables were compared between groups using student t test. Categorical variables were compared using Chi-square test.RESULTS:We identified 57 eligible patients. At the time of COVID-19 diagnosis, 30 (52.6%) were in remission, 0 (0%) had mild disease, 23 (40.3%) had moderate disease activity, and 4 (7.0%) had severe disease activity. No patients discontinued maintenance medications for more than 14 days due to COVID-19 diagnosis. No differences in age, gender, race, body max index, and combordities were noted between those not in remission versus those who were in remission (p>0.05). Patients who were not in remission were more likely to be on steroids at the time of COVID-19 diagnosis (47% vs 0%, p =0.00001) including budesonide and prednisone. Patients who were not in remission were more likely to be on biologics at the time of COVID-19 diagnosis (96.3%% vs 73.3%, p =0.03). Patients in remission had overall low rates of needing escalation in immunosuppressive maintenance therapy and IBD related hospitalization/surgery (6.7% and 0%, respectively). Patients who were not in remission were more likely to require escalation in immunosuppressive maintenance therapy (44.4% vs 6.7%, p 0.0015) and IBD related hospitalization/surgery compared to those in remission (18.5% vs 0.0%, p=0.02). No differences in COVID-19 related outcomes including need for hospitalization, ICU stay, use of COVID-19 related therapy such as monoclonal antibodies, and death were noted between the two groups (p>0.05).CONCLUSION:Our study suggests minimal impact of COVID-19 on IBD related outcomes in patients in remission. Patients who were not in remission did have worse IBD related outcomes compared to those in remission, however, the findings could reflect the natural history of IBD related disease rather than being related to COVID-19. COVID-19 related outcomes were no different in those who were not in remission versus those who were in remission. Future larger scale studies are warranted to study the findings further.

Fecal microbiota transplantation (FMT), which is highly efficacious in treating recurrent C. difficile infection (RCDI), has a promising application in decolonization of multidrug-resistant organisms, reduction of antibiotic resistance gene abundance, and restoration of healthy intestinal microbiota. However, data representing clinical microbiology results after FMT are limited. We sought to characterize the differences in culture positivity and antimicrobial susceptibility profiles in patients with Gram-negative infections in the year before and the year after FMT for RCDI. Drawing on prior studies that had demonstrated the success of FMT in eradicating extraintestinal infections and the occurrence of patient-level interspecies transfer of resistance elements, we employed an agnostic analytic approach of reviewing the data irrespective of body site or species. In a small RCDI population, we observed an improvement in the antimicrobial susceptibility profile of Gram-negative bacteria following FMT, which supports further study of FMT as a strategy to combat antibiotic resistance. Fecal microbiota transplantation (FMT) has promising applications in reducing multidrug-resistant organism (MDRO) colonization and antibiotic resistance (AR) gene abundance. However, data on clinical microbiology results after FMT are limited. We examined the changes in antimicrobial susceptibility profiles in patients with Gram-negative infections in the year before and the year after treatment with FMT for recurrent Clostridioides difficile infection (RCDI). We also examined whether a history of FMT changed health care provider behavior with respect to culture ordering and antibiotic prescription. Medical records for RCDI patients who underwent FMT at Emory University between July 2012 and March 2017 were reviewed retrospectively. FMT-treated patients with Gram-negative culture data in the 1-year period preceding and the 1-year period following FMT were included. Demographic and clinical data were abstracted, including CDI history, frequency of Gram-negative cultures, microbiological results, and antibiotic prescription in response to positive cultures in the period following FMT. Twelve patients were included in this case series. We pooled data from infections at all body sites and found a decrease in the number of total and Gram-negative cultures post-FMT. We compared susceptibility profiles across taxa given the potential for horizontal transmission of AR elements and observed increased susceptibility to nitrofurantoin, trimethoprim-sulfamethoxazole, and the aminoglycosides. FMT did not drastically influence health care provider ordering of bacterial cultures or antibiotic prescribing practices. We observed a reduction in Gram-negative cultures and a trend toward increased antimicrobial susceptibility. This study supports further investigation of FMT as a means of improving antimicrobial susceptibility. IMPORTANCE Fecal microbiota transplantation (FMT), which is highly efficacious in treating recurrent C. difficile infection (RCDI), has a promising application in decolonization of multidrug-resistant organisms, reduction of antibiotic resistance gene abundance, and restoration of healthy intestinal microbiota. However, data representing clinical microbiology results after FMT are limited. We sought to characterize the differences in culture positivity and antimicrobial susceptibility profiles in patients with Gram-negative infections in the year before and the year after FMT for RCDI. Drawing on prior studies that had demonstrated the success of FMT in eradicating extraintestinal infections and the occurrence of patient-level interspecies transfer of resistance elements, we employed an agnostic analytic approach of reviewing the data irrespective of body site or species. In a small RCDI population, we observed an improvement in the antimicrobial susceptibility profile of Gram-negative bacteria following FMT, which supports further study of FMT as a strategy to combat antibiotic resistance.

BackgroundsRecent studies have identified the role of serologic markers in characterizing disease phenotype, location, complications, and severity among Northern Europeans (NE) with Crohn’s disease (CD). However, very little is known about the role of serology in CD among African Americans (AA). Our study explored the relationship between serology and disease phenotype in AA with CD, while controlling for genetic ancestry.MethodsAAs with CD were enrolled as participants through multicenter collaborative efforts. Serological levels of IgA anti-Saccharomyces cervisiae antibody (ASCA), IgG ASCA, E. coli outermembrane porin C, anti-CBir1, and ANCA were measured using enzyme-linked immunosorbent assays. Genotyping was performed using Illumina immunochip technology; an admixture rate was calculated for each subject. Multiple imputation by chained equations was performed to account for data missing at random. Logistic regression was used to calculate adjusted odds ratio (OR) for associations between serological markers and both complicated disease and disease requiring surgery.ResultsA total of 358 patients were included in the analysis. The majority of our patients had inflammatory, noncomplicated disease (58.4%), perianal disease (55.7%), and documented colonic inflammation (86.8%). On multivariable analysis, both IgG ASCA and OmpC were associated with complicated disease (OR, 2.67; 95% CI, 1.67–4.28; OR, 2.23; 95% CI, 1.41–3.53, respectively) and disease requiring surgery (OR, 2.51; 95% CI, 1.49–4.22; OR, 3.57; 95% CI, 2.12–6.00). NE admixture to the African genome did not have any associations or interactions in relation to clinical outcome.ConclusionsOur study comprises the largest cohort of AAs with CD. The utility of serological markers for the prognosis of CD in NE applies equally to AA populations.

Short bowel syndrome (SBS) in neonates is an uncommon but highly morbid condition. As SBS survival increases, physiologic complications become more apparent. Few reports in the literature elucidate outcomes for adults with a pediatric history of SBS. We present a case report of a patient, born with complicated gastroschisis resulting in SBS at birth, who subsequently developed symptoms and pathologic changes of inflammatory bowel disease (IBD) as an adult. The patient lived from age 7, after a Bianchi intestinal lengthening procedure, to age 34 independent of parenteral nutrition (PN), but requiring hydration fluid via G-tube. He was then diagnosed with IBD, after presenting with weight loss, diarrhea, and malabsorption, which required resumption of PN and infliximab treatment. This report adds to a small body of the literature which points to a connection between SBS in neonates and subsequent diagnosis of IBD. Recent evidence suggests that SBS and IBD have shared features of mucosal immune dysfunction and altered intestinal microbiota. We review current treatment options for pediatric SBS as well as multidisciplinary and coordinated transition strategies. We conclude that there may be an etiologic connection between SBS and IBD and that this knowledge may impact outcomes and approaches to care.