Risk of common infections in people with inflammatory bowel disease in primary care: a population-based cohort study

Abstract

ObjectiveTo evaluate the risk of common infections in individuals with inflammatory bowel disease (IBD) [ulcerative colitis and Crohn’s disease] compared with matched controls in a contemporary UK primary care population.DesignMatched cohort analysis (2014–2019) using the Royal College of General Practitioners Research and Surveillance Centre primary care database. Risk of common infections, viral infections and gastrointestinal infections (including a subset of culture-confirmed infections), and predictors of common infections, were evaluated using multivariable Cox proportional hazards models.Results18 829 people with IBD were matched to 73 316 controls. People with IBD were more likely to present to primary care with a common infection over the study period (46% vs 37% of controls). Risks of common infections, viral infections and gastrointestinal infections (including stool culture-confirmed infections) were increased for people with ulcerative colitis and Crohn’s disease compared with matched controls (HR range 1.12–1.83, all p<0.001). Treatment with oral glucocorticoid therapy, immunotherapies and biologic therapy, but not with aminosalicylates, was associated with increased infection risk in people with IBD. Despite mild lymphopenia and neutropenia being more common in people with IBD (18.4% and 1.9%, respectively) than in controls (6.5% and 1.5%, respectively), these factors were not associated with significantly increased infection risk in people with IBD.ConclusionPeople with IBD are more likely to present with a wide range of common infections. Health professionals and people with IBD should remain vigilant for infections, particularly when using systemic corticosteroids, immunotherapies or biologic agents.Trial registration numberClinicaltrials.gov (NCT03835780).

Bacterial Species Associated With Human Inflammatory Bowel Disease and Their Pathogenic Mechanisms

“…However, these enteric infections did not impact IBD outcomes ( Axelrad et al, 2018 ). A recent study from UK also reported that patients with IBD in primary care were more likely to present with common infections including gastrointestinal infections of C. difficile , Salmonella , Shigella and Campylobacter ( Irving et al, 2021 ). Campylobacter species isolated in diagnostic laboratories are mainly Campylobacter jejuni .…”

Inflammatory Bowel Disease and COVID-19: How Microbiomics and Metabolomics Depict Two Sides of the Same Coin

“…The etiology of IBD is multifactorial, including the contribution of genetic, environmental, host factors and their reciprocal interactions ( Flynn and Eisenstein, 2019 ); recent data indicate a worldwide 0.3% incidence and prevalence of IBD ( Ng et al, 2017 ). The therapeutic treatment of IBD with immunomodulators ( Park et al, 2020 ) and biologics ( Neurath, 2019 ) may activate a transient or persistent immunocompromised state inducing opportunistic infections, especially when multiple drugs are prescribed simultaneously ( Bonovas et al, 2016 ; Shah et al, 2017 ; Irving et al, 2021 ). Several research groups investigated whether patients with IBD may be or not more susceptible to developing SARS-CoV-2 infection ( Monteleone and Ardizzone, 2020 ), how they should be managed in the context of the COVID-19 pandemic, and the risks and benefits of the therapeutic treatment with immunomodulators, especially in the pediatric age ( Dipasquale et al, 2020 ; Sultan et al, 2020 ).…”

Corticotrophins, corticosteroids, and prostaglandins

“…To evaluate the risk of common infections in individuals with (IBD) 18 829 people with IBD were matched to 73 316 controls. Authors found that the patients with IBD were more likely to present to primary care with a common infection over the study period (46% vs 37% of controls) ( Irving et al, 2021 ) [M]. Moreover, the risks of infections, was higher in patients who were treated with oral glucocorticoid therapy, but not with aminosalicylates.…”