Introduction

Antimicrobial resistance is a global problem and antibiotic-resistant infections are one of the leading causes of death for people of all ages. Antibiotic-resistant Klebsiella pneumoniae has reached up to 70 percent of global drug resistance rates, with infection-related mortality rates ranging 40-70 percent [1,2]. K. pneumoniae is a causative agent of several types of infections: respiratory, urinary, gastrointestinal tract infections, and many others. Classically, these infections occur in hospitalized or otherwise immunocompromised patients and are routinely treated with β-lactams and other antibiotics effective against Enterobacteriaceae. However, antibiotic-resistant K. pneumoniae has emerged separately across the world [3]. For this reason, there is a rapidly growing demand for new antimicrobial agents, like recombinant bacteriocins, directed against antibiotic-resistant bacteria.

Aims & Methods

The aim of this study was to compare recombinant bacteriocins (klebicin-KvarM) and antibiotic efficacy against K. pneumoniae infection in the gastrointestinal tract. Antimicrobial efficacy of orally delivered klebicin KvarM and antibiotics in treatment of K. pneumoniae infection was tested using four study groups: control group (natural microbiota) (Group 1); K. pneumoniae (ATCC 43816; 10⁷ CFU/50 µl) (Group 2); K. pneumoniae (ATCC 43816; 10⁷ CFU/50 µl) and KvarM coated to be released in the small and large intestines (5 mg/ml) (Group 3); K. pneumoniae (ATCC 43816; 10⁷ CFU/50 µl) and broad-spectrum ciprofloxacin (2 mg/200 µl) (Group 4). From faecal samples, which were collected on different experimental days, we performed real-time polymerase chain reaction (RT-PCR) to detect the amplification of the haemolysin gene (khe), which is a specific marker for Klebsiella genus bacteria.

Results

The gastrointestinal K. pneumoniae infection in mice was achieved orally using pipetting method without antibiotic pre-treatment. After induction of therapy substances once daily for 4 days, there was a significant difference between Group 2 and Group 3 (p = 0,05). In Group 3 the amounts of K. pneumoniae bacteria changed from 1,4 x 10⁶ CFU after K. pneumoniae administration to 1,7 x 10² CFU after the last dose of therapy (63,9 percent efficacy) (p = 0,026). Comparing Group 2 and Group 4 results did not reach statistical significance (p = 0,423). In Group 4 K. pneumoniae count changed from 8,75 x 10⁵ CFU after K. pneumoniaeadministration to 3,51 x 10³ CFU after antibiotic therapy, having 37,1 percent of efficacy (p = 0,1002).

Conclusion

Comparing the antibiotic and bacteriocins efficacy, statistically significant results were obtained – the effect of bacteriocin KvarM was more effective in the treatment of Klebsiella pneumoniae colonization of the digestive tract.

References

1. Murray CJ, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet. 2022;12;399(10325):629–55.
2. Alvarez-Uria G, Gandra S, Mandal S, Laxminarayan R. Global forecast of antimicrobial resistance in invasive isolates of Escherichia coli and Klebsiella pneumoniae. International Journal of Infectious Diseases. 2018;1;68:50–3.
3. Martin RM, Bachman MA. Colonization, infection, and the accessory genome of Klebsiella pneumoniae. Vol. 8, Frontiers in Cellular and Infection Microbiology. Frontiers Media S.A.; 2018.

Disclosure

There was no conflict of interest

Introduction

Prevalence of inflammatory bowel disease (IBD) is increasing worldwide, while incidence is tending to stabilize. Moreover, the use of biological treatments is increasing, some studies suggest that surgeries and hospitalizations are decreasing instead.

Aims & Methods

A population-based, retrospective cohort study was conducted using data from the Catalan Health Surveillance System (CHSS). All patients diagnosed with IBD were included between 2017-2023. Crude incidence and prevalence rates were calculated for all the Catalan population. Data on pharmacological therapy, surgical procedures, hospitalizations, and mortality were analyzed. Trends in age-sex-adjusted rates were also estimated, and logistic regression was used to calculate the adjusted mortality odds ratio (OR). Data for Crohn’s disease (CD) and ulcerative colitis (UC) were analyzed separately.

Results

The number of prevalent IBD cases rose from 28,752 in 2017 to 41,423 in 2023. Despite incidence rates remained stable (30.8 in 2017 and 29.9 per 100,000 inhabitants in 2023) prevalence rates increased (386.9 and 510.9 per 100,000 inhabitants respectively). The use of biologics significantly increased (from 13.5% in 2017 to 21.0% in 2023), particularly ustekinumab and vedolizumab. In parallel, a decline in the use of immunosuppressants were observed. IBD-related surgeries and hospitalizations decreased during study period, particularly among CD patients. Mortality remained low but was higher among IBD patients compared to the general population.

Conclusion

Incidence of IBD in Catalonia has stabilized, while its prevalence continues rising, suggesting a transition to Stage 3 (compounding prevalence). The use of biological treatments is increasing steadily, whereas rates of surgeries and hospitalizations are consistently decreasing.

Disclosure

None