Fiore M. Letter to the Editor: From antibiotic exposure to antibiotic intensity: Rethinking inpatient stewardship in inflammatory bowel disease. World J Gastroenterol 2026; 32(33): 118868 [DOI: 10.3748/wjg.118868]
Corresponding Author of This Article
Marco Fiore, MD, Lecturer, Professor, Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza Miraglia 2, Naples 80138, Italy. marco.fiore@unicampania.it
Research Domain of This Article
Gastroenterology & Hepatology
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letter
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Fiore M. Letter to the Editor: From antibiotic exposure to antibiotic intensity: Rethinking inpatient stewardship in inflammatory bowel disease. World J Gastroenterol 2026; 32(33): 118868 [DOI: 10.3748/wjg.118868]
World J Gastroenterol. Sep 7, 2026; 32(33): 118868 Published online Sep 7, 2026. doi: 10.3748/wjg.118868
Letter to the Editor: From antibiotic exposure to antibiotic intensity: Rethinking inpatient stewardship in inflammatory bowel disease
Marco Fiore
Marco Fiore, Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
Author contributions: Fiore M conceived the study, drafted the manuscript, and approved the final version of the manuscript.
Conflict-of-interest statement: The author declares no conflict of interest in publishing the manuscript.
Corresponding author: Marco Fiore, MD, Lecturer, Professor, Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza Miraglia 2, Naples 80138, Italy. marco.fiore@unicampania.it
Received: January 13, 2026 Revised: February 11, 2026 Accepted: March 3, 2026 Published online: September 7, 2026 Processing time: 208 Days and 21.8 Hours
Abstract
The study by Zeng et al, published in the recent issue of the World Journal of Gastroenterology, present a 10-year real-world analysis of antibiotic use among hospitalized patients with inflammatory bowel disease (IBD) (2015-2024) and provide probabilistic forecasts through 2027. Their data highlight a pivotal stewardship message: Antibiotic exposure prevalence and antibiotic consumption intensity are not interchangeable metrics. Although the proportion of admissions receiving antibiotics declined in 2020-2024 compared with 2015-2019, antibiotic consumption intensity (DDD/100 bed-days) increased significantly, accompanied by a recent rise in broad-spectrum and traditionally “last-resort” agents, including carbapenems and vancomycin. Antibiotic-exposed admissions clustered in older patients and were associated with longer length of stay and higher costs, suggesting that antibiotic burden concentrates in high-acuity episodes rather than being evenly distributed across the inpatient IBD population. The forecasting component showed wide uncertainty but consistently indicated upward pressure on antibiotic burden if current practices and policies remain unchanged. This letter argues that inpatient stewardship in IBD should pivot from counting “exposed admissions” to monitoring intensity, escalation patterns, and indication-specific use, and proposes an IBD-tailored stewardship roadmap integrating diagnostic stewardship, standardized perioperative and intra-abdominal infection pathways, early reassessment with de-escalation, and structured metrics to curb avoidable escalation while preserving clinical outcomes.
Core Tip: Although fewer hospitalized patients with inflammatory bowel disease now receive antibiotics, those treated are exposed to increasingly intensive regimens, with a growing use of broad-spectrum and last-resort agents. This disconnect between exposure prevalence and antibiotic consumption intensity challenges traditional stewardship metrics. An inflammatory bowel disease-tailored inpatient stewardship framework focused on antibiotic intensity, escalation patterns, and indication-specific use, with measurable process and outcome indicators, is urgently needed to preserve antimicrobial effectiveness while safeguarding patient outcomes.
