Gastroenterology

Gastroenterology

Volume 134, Issue 4, April 2008, Pages 929-936
Gastroenterology

Clinical–Alimentary Tract
Risk Factors for Opportunistic Infections in Patients With Inflammatory Bowel Disease

https://doi.org/10.1053/j.gastro.2008.01.012Get rights and content

Background & Aims: We sought to identify and quantify the clinical factors that were associated with opportunistic infections in inflammatory bowel disease patients. Methods: We identified 100 consecutive IBD patients with opportunistic infections. For each case, 2 matched IBD patients who did not have a history of opportunistic infection were selected as controls. Conditional logistic regression was used to assess associations between putative risk factors and opportunistic infections, presented as odds ratios (OR) and 95% confidence intervals (CIs). Results: In univariate analysis, use of corticosteroids (OR, 3.4; 95% CI, 1.8–6.2), azathioprine/6-mercaptopurine (OR, 3.1; 95% CI, 1.7–5.5), and infliximab (OR, 4.4; 95% CI, 1.2–17.1) were associated individually with significantly increased odds for opportunistic infection. Multivariate analysis indicated that use of any one of these drugs yielded an OR of 2.9 (95% CI, 1.5–5.3), whereas use of 2 or 3 of these drugs yielded an OR of 14.5 (95% CI, 4.9–43) for opportunistic infection. The relative risk of opportunistic infection was greatest in IBD patients seen at older than 50 years of age (OR, 3.0; 95% CI, 1.2–7.2, relative to those 24 years or younger). No patient died from opportunistic infection. Conclusions: Immunosuppressive medications, especially when used in combination, and older age are associated with increased risk of opportunistic infections. The absolute risk of opportunistic infection in IBD patients remains to be determined, as does any potential benefit of any preventive strategy.

Section snippets

Cases

This study was reviewed and approved by the Institutional Review Board of Mayo Foundation. The Mayo Clinic Rochester diagnostic index was searched for patients diagnosed with ulcerative colitis or Crohn’s disease, and cross-referenced against lists of patients with various opportunistic infections including viral (eg, cytomegalovirus, Epstein–Barr, herpes simplex, and varicella zoster), fungal (eg, histoplasmosis, candidiasis, and blastomycosis), and bacterial (eg, tuberculosis and

Spectrum of Pathogens and Clinical Syndromes

Between January 1998 and December 2003, we identified 100 consecutive IBD patients who developed an opportunistic infection and who fit the inclusion criteria for this study (Table 1). A wide range of opportunistic infections occurred, arising from viral, fungal, bacterial, and mycobacterial organisms. The severity of these varied considerably, ranging from mucosal herpes infections to a life-threatening systemic fungal infection. One patient developed an Epstein–Barr virus–associated lymphoma.

Discussion

From this case-control study, we have found that the use of corticosteroids, AZA/6MP, or infliximab was associated significantly with the development of opportunistic infections in patients with IBD. Moreover, when used in combination, these drugs synergistically increased the likelihood of an opportunistic infection. These observations firmly establish opportunistic infections as iatrogenic complications of the drug therapy of IBD.

Patients who received corticosteroid therapy were about 2 to 3

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