Introduction

Colonization/infection with multidrug-resistant organisms (MDROs) such as methicillin-susceptible staphylococcus aureus (MSSA), methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum beta-lactamase (ESBL) producing Enterobacterales and carbapenem resistant P. aeruginosa, is an increasing problem being reported worldwide. Rectal, cutaneous and nasal swab screening allows for the detection of MDROs in asymptomatic individuals, enabling early identification and subsequent implementation of infection control measures to prevent transmission.

Aims & Methods

The aim of this study was to determine the prevalence as well as the risk factors of colonization/infection with MSSA, MRSA, VRE, ESBL producing Enterobacterales and carbapenemase producing P. aeruginosa, in patients hospitalized in gastroenterologic and oncologic and surgical unit for gastroenterologic diseases. Methods: all the consecutive patients hospitalized from May 2023 to March 2024 in the abovementioned units at admission underwent rectal swabs to identify the presence of MDROs, primarily methicillin-susceptible staphylococcus aureus (MSSA), methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum beta-lactamase (ESBL) producing Enterobacterales and carbapenemase producing P. aeruginosa. Demographic, clinical and therapeutic variables were evaluated.

Results

242 patients were hospitalized (mean age 65,6 ± 17,8 years; 56% males). MDRO were present in 17,36% of patients (n.42). 7 % of patient tested positive for Escherichia coli ESBL+, 3.7% for Klebsiella pneumoniae ESBL+ and 2.5% for Enterococcus faecium VRE at rectal swab. 2.1% of patient tested positive at nasal swabs for MSSA, 2.1% for MRSA, 0.4% for E. coli ESBL and 0.4% for K. pneumoniae ESBL. 0.4% of patient were positive at cutaneous swab for E. faecium VRE and 0.4% for K. pneumoniae ESBL. At univariate analysis hospitalization within 1 year, ongoing treatment with PPI, ongoing steroid treatment and chronic renal failure were associated to the risk of a positive surveillance swab. At multivariate analysis only hospitalization, ongoing steroid treatment and chronic renal failure were independent predictors of colonization (table).

Conclusion

This research offers information on how common MDROs are among gastroenterology patients. It contributes to the existing knowledge and aids in addressing the spread of MDROs by customizing screening methods based on individual patient factors, like past hospital stay, ongoing steroid treatment and chronic renal failure.

Introduction

Duodenoscopes have been implicated in patient-to-patient transmission of multidrug-resistant organisms (MDROs). Current gastrointestinal MDRO surveillance relies primarily on rectal screening, yet the duodenum is the primary site of duodenoscope exposure to MDRO. This study evaluated the predictive value of rectal and throat-nose screening for detecting MDROs in duodenal fluid as a marker of duodenoscope contamination risk.

Aims & Methods

The aim of this study was to evaluate the predictive value of rectal and throat-nose screening for detecting MDROs in duodenal fluid as a marker of duodenoscope contamination risk. This study was conducted at two tertiary care centers in India and the Netherlands. Adult patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) were included. Rectal swabs, throat-nose swabs, and duodenal aspirates were collected and analyzed for MDROs. The detected MDROs were compared using species identification, antibiotic susceptibility patterns, and whole-genome sequencing.

Results

A total of 512 participants were included: 339 from the Netherlands and 173 from India. Rectal MDRO carriage was observed in 33.8% (173/512), throat-nose carriage in 0.2% (1/512), and duodenal carriage in 22.9% (117/512). Due to the low prevalence of carriage in the nose or throat, only the predictive value efficacy of rectal screening was assessed. Rectal screening showed a sensitivity of 38.5% for genetically related strains in duodenal fluid. For detecting any duodenal MDRO, rectal screening demonstrated a sensitivity of 90.6%, specificity of 83.0%, a positive predictive value (PPV) of 61.3%, and a negative predictive value (NPV) of 96.7%.

Conclusion

Rectal screening is unreliable for detecting strain-specific duodenal MDROs. While effective in identifying non-carriers, it overestimates true duodenal MDRO carriage. Thus, utility of rectal screening in guiding infection prevention strategies for duodenoscope contamination is greater in regions with low MDRO prevalence.

Disclosure

This study was supported by an unrestricted research grant from Boston Scientific and received material support from Copan Italia SpA. The study was investigator-initiated, and neither Boston Scientific nor Copan Italia had any role in the design of the study protocol, data analysis, interpretation of results, or preparation of the abstract.

Introduction

Endoscopic retrograde cholangiopancreatography (ERCP) poses a risk of patient-to-patient transmission of multidrug-resistant organisms (MDROs) via contaminated duodenoscopes. The prevalence of MDRO carriage in ERCP patients is unknown but crucial for assessing this risk and to determine the impact and choice of targeted infection prevention measures.

Aims & Methods

The aim of this study was to measure MDRO prevalence in ERCP patients across four countries. This observational study included adults undergoing ERCP in the Netherlands, India, Italy, and the United States. Pre-procedural rectal and throat-nose swabs were collected for MDRO detection. Patient- and procedure-related data were systematically collected. Risk factors for MDRO carriage were determined through multivariate logistic regression analysis.

Results

Of 1244 patients, 462 (37.1%) carried an MDRO. Extended-spectrum beta-lactamase-producing Enterobacterales were most common (337/1244, 27.1%), followed by carbapenemase-producing Enterobacterales (94/1244, 7.6%). MDRO prevalence exhibited significant geographical variation, highest in India (83.1%) and lowest in the Netherlands (10.8%), with intermediate rates in Italy (31.6%) and the United States (20.1%). Additionally, MDRO types varied substantially across countries. Pre-procedural MDRO carriage was significantly associated with chronic lung disease (aOR 1.75, 95% CI 1.07–2.86, P = 0.025), congestive heart failure (aOR 2.20, 95% CI 1.33–3.64, P = 0.002), and prior penicillin use (aOR 1.66, 95% CI 1.05–2.63, P = 0.031).

Conclusion

Patients undergoing ERCP have a moderate to high prevalence of MDRO carriage, with significant variation in prevalence, species, and resistance mechanisms across countries. High MDRO prevalence increases the risk of duodenoscope contamination by MDRO and subsequent patient-to-patient transmission via these contaminated endoscopes. Pre-procedural screening could enable targeted infection prevention measures, including enhanced reprocessing or the use of single-use duodenoscopes, to reduce the risk of future duodenoscope-related MDRO outbreaks.

Disclosure

This study was supported by an unrestricted research grant from Boston Scientific and received material support from Copan Italia SpA. The study was investigator-initiated, and neither Boston Scientific nor Copan Italia had any role in the design of the study protocol, data analysis, interpretation of results, or preparation of the abstract.

Introduction

Helicobacter pylori (HP) infection is the most significant environmental factor contributing to gastric carcinogenesis. However, the rising prevalence of antibiotic resistance in HP has become a global concern. Currently, there is limited research on the correlation between HP antibiotic resistance and early gastric cancer (EGC). This study aimed to detect HP resistance genes in EGC patients using qRT-PCR on paraffin-embedded ESD specimens and explore the association between HP resistance and EGC.

Aims & Methods

A total of 150 EGC patients who underwent endoscopic submucosal dissection (ESD) between January 1, 2023, and December 31, 2024, were enrolled. HP resistance genes were detected in post-ESD gastric mucosal paraffin sections. Resistance rates to various antibiotics were compared, and correlations between resistance and clinicopathological features were analyzed.

Results

Among the 150 EGC patients, 28 (18.67%) were HP-positive, with 18 (64.3%, 95% CI: 44.1%–81.4%) showing antibiotic resistance. Levofloxacin had the highest resistance rate (50.0%), followed by clarithromycin (38.9%), tetracycline (11.1%), and amoxicillin (5.6%). No resistance to furazolidone was observed. Multidrug resistance analysis revealed common combinations, including clarithromycin + quinolone (22.2%) and clarithromycin + quinolone + tetracycline (5.6%). No significant correlations were found between resistance and clinicopathological features such as tumor location, size, histologic type, differentiation, depth of invasion, or mucosal status (all *p* > 0.05).

Conclusion

HP antibiotic resistance is prevalent in EGC patients, with high resistance rates to levofloxacin and clarithromycin. However, no significant association was observed between HP resistance and clinicopathological characteristics of EGC. Further studies are needed to elucidate the role of resistant HP strains in gastric carcinogenesis.

References

[1]Yang L, Kartsonaki C, Yao P, de Martel C, Plummer M, Chapman D, Guo Y, Clark S, Walters RG, Chen Y, Pei P, Lv J, Yu C, Jeske R, Waterboer T, Clifford GM, Franceschi S, Peto R, Hill M, Li L, Millwood IY, Chen Z; China Kadoorie Biobank Collaborative Group. The relative and attributable risks of cardia and non-cardia gastric cancer associated with Helicobacter pylori infection in China: a case-cohort study. Lancet Public Health. 2021 Dec;6(12):e888-e896. doi: 10.1016/S2468-2667(21)00164-X.
[2]Lee YC, Chiang TH, Chou CK, Tu YK, Liao WC, Wu MS, Graham DY. Association Between Helicobacter pylori Eradication and Gastric Cancer Incidence: A Systematic Review and Meta-analysis. Gastroenterology. 2016 May;150(5):1113-1124.e5. doi: 10.1053/j.gastro.2016.01.028. Epub 2016 Feb 2.
[3]Dingsdag SA, Hunter N. Metronidazole: an update on metabolism, structure-cytotoxicity and resistance mechanisms. J Antimicrob Chemother. 2018 Feb 1;73(2):265-279. doi: 10.1093/jac/dkx351.
[4]Dingsdag SA, Hunter N. Metronidazole: an update on metabolism, structure-cytotoxicity and resistance mechanisms. J Antimicrob Chemother. 2018 Feb 1;73(2):265-279. doi: 10.1093/jac/dkx351.
[5]Lee SM, Kim N, Kwon YH, Nam RH, Kim JM, Park JY, Lee YS, Lee DH. rdxA, frxA, and efflux pump in metronidazole-resistant Helicobacter pylori: Their relation to clinical outcomes. J Gastroenterol Hepatol. 2018 Mar;33(3):681-688. doi: 10.1111/jgh.13906.

Introduction

Gastrointestinal bleeding (GIB) and Ischemic heart disease (IHD) both remain the important causes of morbidity and mortality. Patients with IHD are more likely to suffer from GIB due to the characteristics of the population, heart disease, stress state and long-term use of antithrombotic drugs^[1-3]. Previous studies have found that patients with simultaneous GIB and IHD have higher mortality than that of each individual disease^[4-5]. Treatment for those patients is a challenge for both the cardiologists and gastroenterologists. In order to assess the frequency of in-hospital mortality in patients with GIB and IHD, and determine the potential risk factors for this condition, we designed and conducted this single center study.

Aims & Methods

Our study assessed the hospitalized outcomes of patients with simultaneous GIB and IHD. Moreover, we explored the risk factors of in-hospital mortality in those patients.We performed a retrospective study in West China hospital between January 2014 and December 2018. Patients diagnosed with GIB and IHD were included. The primary outcome was in-hospital mortality for all causes. Clinical and laboratory data were collected and analyzed for clinical characteristics and potential risk factors of in-hospital mortality.

Results

574 GIB patients with IHD were enrolled in the current study, and among them 107 in-hospital deaths were observed (in-hospital mortality rate of 18.64%). The causes of death included cardiovascular death (46, 42.99%), hemorrhagic shock (10, 9.35%), severe infection (33, 30.84%), and other causes (18, 16.82%). Patients who died were older than survivors [78（68, 82） vs. 74（65, 80），P = 0.008], with a higher incidence of COPD (27.10% vs. 13.70%, P=0.001) and chronic renal failure (47.66% vs. 27.19%, P<0.001). Patients with a higher heart rate at admission (90 vs. 81, P=0.006), or with a course of CHD less than 3 months (53.27% vs. 32.76%, P<0.001) were more likely to die. More patients in death group received plasma infusion (24.30% vs. 7.92%, P<0.001), and present with acute coronary syndrome (53.27% vs. 38.97%, P=0.007). Compared with survivors, patients who died showed increased peak white blood cell (WBC) count [18.75(14.35, 24.9) vs. 9.79 (7.19, 13.82) ×109/L,P < 0.001], increased peak INR [1.51 (1.21, 2.58) vs. 1.13 (1.05, 1.31),P < 0.001)], and lower minimum platelet counts [94 (52, 147) vs. 128 (83, 180)×109/L, p<0.001]. In multivariable logistic analysis, age [OR (95% CI) =1.032 (1.006-1.058), P=0.014], peak WBC count [OR (95% CI) =1.123 (1.085-1.163), P<0.001], peak INR levels [OR (95%CI) =1.220(1.061-1.402), P=0.005], and heart rate at admission [OR (95%CI) =1.015(1.002-1.028), P=0.026] were independent predictors of in-hospital mortality.

Conclusion

Patients with simultaneous GIB and IHD had a high in-hospital mortality. Age, peak WBC count, peak INR levels, and heart rate at admission were independent risk factors for in-hospital death.

References

[1]. Steg PG, Huber K, Andreotti F, Arnesen H, Atar D, Badimon L, Bassand JP, De Caterina R, Eikelboom JA, Gulba D, Hamon M, Helft G, Fox KA, Kristensen SD, Rao SV, Verheugt FW, Widimsky P, Zeymer U, Collet JP. Bleeding in acute coronary syndromes and percutaneous coronary interventions: position paper by the Working Group on Thrombosis of the European Society of Cardiology. Eur Heart J. 2011 Aug;32(15):1854-64.
[2]. Cea Soriano L, Lanas A, Soriano-Gabarró M, García Rodríguez LA. Incidence of Upper and Lower Gastrointestinal Bleeding in New Users of Low-Dose Aspirin. Clin Gastroenterol Hepatol. 2019 Apr;17(5):887-895.e6.
[3]. Kawasaki K, Kurahara K, Yanai S, Kochi S, Fuchigami T, Matsumoto T. Low-Dose Aspirin and Non-steroidal Anti-inflammatory Drugs Increase the Risk of Bleeding in Patients with Gastroduodenal Ulcer. Dig Dis Sci. 2015 Apr;60(4):1010-5. ​
[4]. Manoukian SV, Feit F, Mehran R, et al. Impact of major bleeding on 30-day mortality and clinical outcomes in patients with acute coronary syndromes: an analysis from the ACUITY trial. J Am Coll Cardiol 2007;49:1362-8
[5]. Rao SV, O'Grady K, Pieper KS, et al. Impact of bleeding severity on clinical outcomes among patients with acute coronary syndromes. Am J Cardiol 2005;96:1200-6.

Introduction

Eosinophilic esophagitis (EoE) is a chronic and progressive disease characterized by eosinophil-predominant inflammation of the esophagus. First-line therapy is represented by topical corticosteroids with anti-inflammatory effects, in particular budesonide orodispersible tablets (BOT). Their efficacy and safety are nowadays well established, but very low number of patients develop oral and esophageal candidiasis.

Aims & Methods

The aim of the study is to evaluate risk factors for the development of oral and esophageal candidiasis during budesonide therapy in eosinophilic esophagitis patients. To date, these data have not still been studied. A retrospective study was conducted to include all EoE patients in therapy with BOT referred to Fondazione Policlinico Universitario A. Gemelli IRCCS between March 2022 and November 2023. Prevalence, localization, and time of presentation of candidiasis were evaluated. Histological findings, in particular eosinophilic count in gastroscopy before BOT therapy were analyzed. Concomitant treatment with proton-pump inhibitors (PPI) and its dosage were reviewed. In addition, each case of discontinuation of BOT for disabling candidiasis was studied.

Results

A total of 52 EoE patients in BOT therapy, 44 males and 8 females, were included in the study. 7 patients (13%) developed oral and/or esophageal candidiasis, in particular 6 patients (85%) during induction phase (1 mg bid) and 1 patient (15%) during early maintenance phase (0.5 mg bid). All these 7 patients presented peak eosinophil count >35/HPF before corticosteroid treatment, with mean count of 46 eos/HPF. 4 patients (57%) of this group were in concomitant PPI therapy at 40 mg per day or more dosage. 3 patients (42%) presented recurrent and severe oral candidiasis inducing discontinuation of treatment.

Conclusion

Oral and esophageal candidiasis is a well-known side effect of budesonide orodispersible tablets in eosinophilic esophagitis. Our results suggest that consistent eosinophilic count (> 35/HPF) and concomitant PPI therapy could represent risk factors in developing mycosis in EoE patients. According to literature, major esophageal inflammation, PPI-induced elimination of the gastric acid barrier and corticosteroid immunosuppression are the main mechanisms leading to oral and esophageal candida colonization. Concomitant use of PPI during BOT treatment in eosinophilic esophagitis should be carefully evaluated, especially in patients with elevated eosinophilic count.

References

Lucendo AJ, Miehlke S, Schlag C, Vieth M, von Arnim U, Molina-Infante J, Hartmann D, Bredenoord AJ, Ciriza de Los Rios C, Schubert S, Brückner S, Madisch A, Hayat J, Tack J, Attwood S, Mueller R, Greinwald R, Schoepfer A, Straumann A; International EOS-1 Study Group. Efficacy of Budesonide Orodispersible Tablets as Induction Therapy for Eosinophilic Esophagitis in a Randomized Placebo-Controlled Trial. Gastroenterology. 2019 Jul;157(1):74-86.e15. doi: 10.1053/j.gastro.2019.03.025. Epub 2019 Mar 26. PMID: 30922997.

Mohamed AA, Lu XL, Mounmin FA. Diagnosis and Treatment of Esophageal Candidiasis: Current Updates. Can J Gastroenterol Hepatol. 2019 Oct 20;2019:3585136. doi: 10.1155/2019/3585136. PMID: 31772927; PMCID: PMC6854261.

Daniell HW. Acid suppressing therapy as a risk factor for Candida esophagitis. Dis Esophagus. 2016 Jul;29(5):479-83. doi: 10.1111/dote.12354. Epub 2015 Apr 1. PMID: 25833302.

Introduction

Gastric adenoma is recognized as a premalignant lesion.¹Much of the literature lumps all adenomas together with different classifications. These are few western reports regarding the prevalence, associated risk factors and outcomes of endoscopic management of different subtypes of gastric adenoma.

Aims & Methods

Aims: The aim of this study is to determine the prevalence, potential predictors, and outcomes of endoscopic management of the different subtypes of gastric adenoma.
Methods: Of 162 consecutive patients who underwent endoscopic resection for gastric lesions between 2017 and 2022 at our center, 79 patients were enrolled. All the hyperplastic polyps (n=37) and subepithelial lesions (n=46) were excluded. The patient clinical characteristics, endoscopic and histopathological features of gastric lesions were retrospectively collected. Patients were divided according to the histological types of gastric adenoma into 4 groups: intestinal group (n= 49), foveolar group (n= 23),pyloric group (n= 6) and oxyntic group (n=1). We statistically compared the clinical and endoscopic features of the three groups. In addition to the analysis of the outcomes of endoscopic resection of gastric adenomas.

Results

Of the 79 patients with a mean follow-up of 2622 months, 51 patients were males (65 %) and 28 patients were females (35%). Forty-nine patients (49/79,62%) had intestinal adenoma, 23 patients (29%) showed foveolar adenoma, 6 patients (8%) developed pyloric adenoma and only 1 patient (1%) had oxyntic adenoma. The mean age was significantly older in the intestinal group (71 ± 13 years vs. 64 ± 16 years vs. 58 ± 18 years, p = 0.03). Intestinal adenomas were significantly associated with family history of gastric adenocarcinoma (14% vs. 4% vs. 0%, p = 0.01) and history of statin intake (39% vs. 26% vs. 0%, p = 0.04).Foveolar adenomas were significantly associated with multiple lesions (≥3 lesions) (p < 0.001) and 0-IIa+IIc Paris classification (6/23, 26%). the size of largest polyp was significantly higher among pyloric group (28 ±15, p= 0.00). Among intestinal group, 33/49 patients (67%) had atrophic gastritis. 82% of the adenomas were resected by ESD with histologically complete resection (R0) in 72/79 patients (91%). Although the difference was not statistically significant (p = 0.4), adenocarcinoma was most frequently encountered among the intestinal adenoma group (17/49, 35%). The post endoscopic resection outcome was comparable among 3 groups with overall recurrence rate (group1:8% vs. group 2:17% vs group 3:17%, P = 0.07) with a comparable mean time to recurrence among three groups (21 ± 17 months vs. 20±17months vs. 14 months, p=0.8). Family history of gastric adenocarcinoma (HR=1.33, p< 0.001) and active helicobacter pylori infection (HR=1.14, p < 0.001) were identified as independent predictors of recurrence after endoscopic resection of different gastric adenoma. Among baseline endoscopic characteristics, polyp size ³ 30mm(HR= 2.04, p< 0.001), more than 3 polyps (HR=1.51, p<0.001), lesser curvature as lesion location (HR=1.72, p< 0.001) and morphology as Paris classification IIc are potential predictors of post resection recurrence. In addition to specimen size ³ 15mm (HR=2.19, p< 0.001) and T1b as lesion histology (HR=2.07, p< 0.001), in the histopathological examination.

Conclusion

The present study clarifies the endoscopic and histopathological characteristics of different gastric adenomas, in addition to the potential predictive factors for each subtype. Potential predictors of recurrence after endoscopic resection emphazie the importance of endoscopic follow up.

References

1. Fujiwara, Y. et al. Diagnosis of borderline adenomas of the stomach by endoscopic mucosal resection. Endoscopy 28, 425–430 (1996).