Objectives
Patients with inflammatory bowel disease (IBD) may be at increased risk for pneumocystis jiroveci pneumonia (PCP). Our aims were 1) to determine the incidence and relative risk of PCP in IBD and 2) to describe medication exposures in IBD patients with PCP.
Methods
We performed a retrospective cohort study and a case series using administrative data from IMS Health Inc, LifeLink™ Health Plan Claims Database. In the cohort, IBD patients were matched to 4 individuals with no IBD claims. PCP risk was evaluated by incidence rate ratio (IRR) and adjusted Cox proportional hazards modeling. The demographics and medication histories of the 38 cases of PCP in IBD patients were extracted.
Results
The cohort included 50,932 patients with CD, 56,403 patients with UC, and 1269 with unspecified IBD; matched to 434,416 individuals without IBD. The crude incidence of PCP was higher in the IBD cohort (10.6/100,000) than in the non-IBD cohort (3.0/100,000). In adjusted analyses, PCP risk was higher in the IBD vs. non-IBD cohort (HR 2.96, 95% CI 1.75–4.29), with the greatest risk in Crohn’s disease (CD) as compared to non-IBD (HR 4.01, 95% CI 1.88–8.56). In the IBD case series of PCP cases (n=38), the median age was 49 (IQR 43–57). A total of 20 (53%) were on corticosteroids alone or in combination with other immunosuppression.
Conclusions
Although the overall incidence of PCP is low, patients with IBD are at increased risk. IBD patients with PCP are predominantly on corticosteroids alone or in combination prior to PCP diagnosis.
The incidence of intestinal infections among hospitalized IBD patients has increased over the past 15 years, primarily driven by C. difficile infections. Intestinal infections are associated with length of stay, hospital charges, and all-cause mortality. More aggressive measures for prevention of C. difficile infections are needed. 10.1093/ibd/izy086_video1izy086.video15779257979001.
Better surveillance and reporting of opportunistic infections including PJP are needed to elucidate risk factors for acquisition of infection. Gastroenterology providers should continue to evaluate the need for PJP prophylaxis on a case-by-case basis to recognize patients who may benefit from primary PJP prophylaxis. In particular, older patients on corticosteroids, multiple immunosuppressive agents, and patients with lymphopenia should be considered for prophylaxis.
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