Prof Eugene Athan
Patients recently recovered from enterococcal bacteraemia should be routinely referred for colonoscopy due to their increased risk of bowel cancer, Australian research suggests.
According to a Victorian study of 376 patients diagnosed with enterococcal bacteraemia between 2010 and 2017, the most frequent comorbidities were gastrointestinal disease, urological disease, malignancies and cardiovascular disease.
Previously undiagnosed colorectal neoplasia was identified in nine of 12 patients referred for colonoscopy solely because of their infection. The median age of the patients was 71 years.
The study found both urological malignancy and colorectal cancer predicted one-year mortality in the study group (OR 3.57 and 4.47 respectively).
Lead author Professor Eugene Athan, director of infectious diseases at Barwon Health, told the limbic the findings were consistent with recent European studies.
For example, a 2017 Spanish study found colorectal cancer in more than half of patients with an Enterococcus faecalis infective endocarditis and an unclear source of infection.
“These are bacteria that all of us carry in our gut normally in the healthy state but when there is some sort of pathology in the mucosal lining of the bowel, that can erode the wall of the bowel and the bacteria end up in the bloodstream,” Professor Athan said.
He recommended that patients with a recent history of E. faecalis or Streptococcus gallolyticus bacteraemia or infective endocarditis should be referred for colonoscopy about 4-6 weeks after their acute episode.
He said the referral should not be delegated to GPs.
“The GP will obviously follow up the patient after a hospital stay but they may not be aware of this association so they may not routinely organise for an outpatient colonoscopy.”
“If someone has had an acute hospital stay it really is up to those medical and surgical teams to ensure that follow-up is done.”
Professor Athan said the association between infection and colorectal cancer was probably not new but was also a manifestation of ageing.
“I think what is happening is that people are living longer so we are seeing the development of bowel pathology in older patients who come into hospital and present with an infection.”
“Bleeding, family history or this infection increase the risk of bowel cancer very significantly and those people should have more frequent endoscopy.”