Distinct Microbiological Profile of Intra-Abdominal Abscesses in Crohn's Disease: A Multicenter Cohort Study from GETECCU.

Abstract

Objective: Intra-abdominal abscesses are a common and severe complication of penetrating Crohn's disease (CD). Data on their microbiological profile are scarce, yet essential for optimizing antibiotic strategies. The aim of our study is to analyse the differences between the pathogens found in patients with CD and in the control group, as well as their resistance rates.

Patients and methods: We conducted a multicenter, observational study using data from the ENEIDA registry and a control cohort recruited at a tertiary hospital. CD patients with intra-abdominal abscesses requiring hospitalization between 2011 and 2021 were included. Controls were patients with non-CD intra-abdominal abscesses from the same timeframe.

Results: A total of 145 CD patients and 156 controls were analyzed. Controls were older (58 vs 42 years, p<0.001), while sex distribution was similar. Escherichia coli was the most frequent pathogen in both cohorts. Streptococcus was more frequent in CD (29% vs. 14%, p=0.02), whereas Pseudomonas was more frequent in controls (12% vs. 1.4%, p=0.016). In the multivariate analysis, the absence of CD and pelvic abscess location were independently associated with the presence of Pseudomonas. Resistance rate was significantly higher in CD patients receiving immunosuppressive therapy (70.5% vs 50.6%, P=0.030). Antibiotic empirical regimens differed, but adequate coverage was similar (80% vs. 77%) between groups.

Conclusions: CD-associated intra-abdominal abscesses display a distinct microbiological profile, with a higher prevalence of Streptococcus, whereas the prevalence of Pseudomonas is exceptional.