Relevant Infections in Inflammatory Bowel Disease, and Their Relationship With Immunosuppressive Therapy and Their Effects on Disease Mortality

Abstract

Background and Aims There is controversy as to whether the risk of relevant infection in IBD is related to immunosuppressants or the disease itself. The aims of this study were to evaluate: [1] the life-long prevalence and types of relevant infections in patients with IBD related to immunosuppressive treatment, and [2] the relationship of both infection and patient comorbidity to mortality. Methods Observational multicentre retrospective study of IBD patients that presented a relevant infection. For each case, four periods of infection exposure were analysed: P1: pre-IBD diagnosis, P2: from IBD diagnosis to immunosuppressant initiation, P3: during immunosuppressant therapy, and P4: after treatment withdrawal. Results The life-long prevalence of relevant infection in the total cohort of patients [6914] was 3%, and 5% in immunosuppressed patients [4202]. 366 relevant infections were found in 212 patients [P1: 9, P2: 17, P3: 334, and P4: 6]. Differences between periods were significant [p < 0.0001]. The most frequent types of infection were respiratory, intestinal and urinary. The most frequent opportunistic infections were tuberculosis [prevalence: 2.6/1000] and herpes zoster [prevalence: 3.9/1000]. Herpes zoster infection was associated with thiopurines alone or in combination with anti-TNF in 75% of the cases, whereas tuberculosis was associated with anti-TNF in 94% of patients. The overall mortality was 4.2%. Infection-related mortality was 2.8% and it was not influenced by comorbidity. Conclusions Relevant infections in IBD patients are rare and appear to be related to immunosuppression. Relevant infection is a major cause of death in IBD.

Addendum to S3-Guidelines Crohn’s disease and ulcerative colitis: Management of Patients with Inflammatory Bowel Disease in the COVID-19 Pandemic – open questions and answers

“…Thus, the case numbers are too low to allow reliable conclusions to be drawn. Without doubt, the overall risk of bacterial and viral infections is significantly increased in patients under immunosuppressive therapy or steroids; these drugs also cause increased mortality [39]. Epidemiological studies from Lombardy in Italy including 1,193 patients with psoriasis receiving biologics show an increased risk for infection, but not for severe disease, as defined by a need for intensive medical care, or death (see ▶ Table 3) [40].…”

“…patients with low risk face mask (covering the mouth and nose) gloves protective goggles or protective visor waterproof long-sleeved single-use gown patients with high risk positive COVID-19 diagnosis FFP2 or FFP3 mask double gloves hair protection protective goggles or protective visor waterproof long-sleeved single-use gown Without any doubt, the overall risk of bacterial and viral infections is significantly increased in patients under immunosuppressive or steroid therapy; these drugs also cause increased mortality [39]. In contrast, treatment with vedolizumab does not seem to increase the risk of respiratory tract infection [52].…”

Addendum zu den S3-Leitlinien Morbus Crohn und Colitis ulcerosa: Betreuung von Patienten mit chronisch entzündlichen Darmerkrankungen in der COVID-19-Pandemie – offene Fragen und Antworten

“…Ohne Zweifel ist insgesamt das Risiko für Infektionen bei Patienten mit einer immunsuppressiven Therapie bzw. einer Steroidmedikation signifikant erhöht; diese bedingen auch eine erhöhte Mortalität [39]. Im Gegensatz dazu scheint die Behandlung z.…”

Recovery from COVID-19 Pneumonia in a Patient with Acute Severe Colitis

“…Since then, great concern has been raised regarding the impact of this disease on specific populations at a higher risk for infection, such as IBD patients. Several previous reports have well described the association among immunosuppressive treatment, disease activity, and malnutrition, with a higher frequency and severity of infections in IBD patients [3, 4]. However, it is still uncertain whether these features constitute additional risks for SARS-CoV-2 infection beyond those already described for the general population, such as elderly, pregnant, hypertensive, and diabetic patients [7, 8].…”

“…For patients with inflammatory bowel disease (IBD), especially those on immunosuppressive therapies or with active disease, the current pandemic requires several new considerations. Previous studies have shown that disease activity and exposure to thiopurines increase the risk of viral infections [3, 4]. However, there is expert agreement that IBD patients are not at a greater risk of developing SARS-CoV-2 infection than the general population [5].…”