Infliximab and other immunomodulating drugs in patients with inflammatory bowel disease and the risk of serious bacterial infections

Schneeweiss, S.; Korzenik, Joshua R.; Solomon, Daniel H.; Canning, Claire; Lee, Joy; Bressler, Brian

doi:10.1111/j.1365-2036.2009.04037.x

Cited by 201 publications

(146 citation statements)

References 24 publications

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“…All of these studies were primarily adult studies and CDI was not mentioned as an opportunistic infection. One adult study concluded no increased rate of serious bacterial infection in IBD patients on biologic (infliximab) therapy, including CDI, although the risk of CDI was increased by three times with corticosteroid use (14). This study primarily included adult CDI patients who required inpatient hospitalizations and excluded outpatient CDI diagnosis to overcome technical difficulties in analysis.…”

Section: Discussionmentioning

confidence: 99%

Clostridium difficile Infection in Pediatric Inflammatory Bowel Disease Patients in the Era of Molecular Diagnostics and Advanced Therapeutics

Patel¹

2017

IJPN

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ObjectiveIncreased prevalence of Clostridium difficile infection (CDI) in pediatric Inflammatory Bowel Disease (IBD) has been reported, primarily using stool toxin assay. Stool Polymerase Chain Reaction (PCR) testing for CDI has replaced toxin assay due to the higher sensitivity and specificity. No pediatric study has reviewed exclusive PCR testing to report CDI in IBD patients. Objective of this study is to analyze demographic and clinical features in IBD patient's age 18 years and less, including Crohn's disease (CD) or ulcerative colitis (UC) who had CDI diagnosed by PCR at a tertiary children's hospital. Materials and MethodsIBD patients with CDI were identified retrospectively from October, 2010 -June, 2014. Patients' demographics, IBD characteristics and treatment, treatment of CDI, response and recurrence were recorded. Comparisons between groups were analyzed using non-parametric tests. Results Forty three CD and 27 UC patients with CDI were identified. CDI presentation was abdominal cramping, diarrhea with or without bleeding. Higher percentage of CDI in CD 28/43 (65%) did not have gross bleeding compared to 11/27 (41%) UC (p= 0.05). Significantly higher proportion of CD versus UC patients was on Infliximab. Majority of patients (64/70; 91%) received metronidazole. ConclusionsCDI should be considered while evaluating pediatric patients with IBD flare up. Absence of blood in stool does not rule out CDI. CD patients on infliximab had a significantly higher proportion of CDI in our study. Most patients responded to metronidazole in both groups. Future studies are needed to evaluate risk of CDI associated with biologic therapy.

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Section: Discussionmentioning

confidence: 99%

Clostridium difficile Infection in Pediatric Inflammatory Bowel Disease Patients in the Era of Molecular Diagnostics and Advanced Therapeutics

Patel¹

2017

IJPN

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“…La inmunosupresión también es un importante factor de riesgo. En un estudio reciente 40 , el tratamiento con corticoesteroides se ha asociado con ICD en pacientes con EII. El efecto de los corticoesteroides no se encontró que sea dosis o duración dependiente.…”

Section: Poblaciones Especialesunclassified

Abordaje multidisciplinario de la infección por Clostridium difficile

Pérez

Hurtado

Couto

et al. 2013

Rev. chil. infectol.

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“…Studies on imumunosuppression with corticosteroids have also reported conflicting results, some finding no association with the risk of CDI in IBD patients, others reporting an increased risk of CDI (36). Schneeweiss et al (36) found that corticosteroid initiation tripled the risk of CDI among the IBD patients (relative risk 3.4, 95% CI 1.9-6.1), while no such association with the initiation of immunomodulators or biologics (infliximab) was found. Biological agents (e.g., infliximab, adalimumab) are not associated with increased risk of CDI in IBD patients (36), nor is the use of aminosalicylates (34).…”

Section: Risk Factorsmentioning

confidence: 99%

“…Schneeweiss et al (36) found that corticosteroid initiation tripled the risk of CDI among the IBD patients (relative risk 3.4, 95% CI 1.9-6.1), while no such association with the initiation of immunomodulators or biologics (infliximab) was found. Biological agents (e.g., infliximab, adalimumab) are not associated with increased risk of CDI in IBD patients (36), nor is the use of aminosalicylates (34). PPI use in non-IBD patients has been suggested to increase the risk for CDI (6), but other studies did not find any association between PPI use and CDI in IBD patients (10).…”

Section: Risk Factorsmentioning

confidence: 99%

Clostridium difficile infection and inflammatory bowel disease

Cojocariu

Stanciu

Stoica³

et al. 2020

Turk J Gastroenterol

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Over the past 15 years, Clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD) has increased both in incidence and severity. Traditional risk factors for CDI are similar in IBD and non-IBD populations, but there is a significant proportion of IBD patients which have distinctive characteristics. Patients with ulcerative colitis (UC) are more susceptible to CDI and have more severe outcomes than those with Crohn's disease (CD). CDI may be difficult to distinguish from an IBD flare due to similar clinical presentation, and therefore screening for CDI is recommended at every flare in such patients. Several studies showed worse clinical outcomes in IBD patients with CDI, including longer hospital stay, higher colectomy and mortality rates than in those without CDI. Vancomycin and metronidazole appear to have similar efficacy in patients with moderate disease, but vancomycin is preferred in severe disease. Measures must be taken to prevent the spread of infection. Clinicians should have a high index of suspicion for CDI when evaluating a patient with IBD flare, as rapid detection and prompt treatment of infection improve outcomes. This review summarizes the available literature on epidemiology, risk factors, clinical aspects, diagnostic methods, treatment, outcome, and prevention of CDI in IBD patients.

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Infliximab and other immunomodulating drugs in patients with inflammatory bowel disease and the risk of serious bacterial infections

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Cited by 201 publications

References 24 publications

Clostridium difficile Infection in Pediatric Inflammatory Bowel Disease Patients in the Era of Molecular Diagnostics and Advanced Therapeutics

Clostridium difficile Infection in Pediatric Inflammatory Bowel Disease Patients in the Era of Molecular Diagnostics and Advanced Therapeutics

Abordaje multidisciplinario de la infección por Clostridium difficile

Clostridium difficile infection and inflammatory bowel disease

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