Risk Factors for Opportunistic Infections in Patients With Inflammatory Bowel Disease

Murat Toruner, Edward Vincent Loftus, Jr, W. Scott Harmsen, Alan R. Zinsmeister, Robert Orenstein, William J. Sandborn, Jean Frederic Colombel, Laurence J. Egan

Research output: Contribution to journalArticle

690 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)929-936
Number of pages8
JournalGastroenterology
Volume134
Issue number4
DOIs
StatePublished - Apr 2008

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Opportunistic Infections
Inflammatory Bowel Diseases
Odds Ratio
Confidence Intervals
6-Mercaptopurine
Azathioprine
Immunosuppressive Agents
Pharmaceutical Preparations
Adrenal Cortex Hormones
Multivariate Analysis
Logistic Models

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Toruner, M., Loftus, Jr, E. V., Harmsen, W. S., Zinsmeister, A. R., Orenstein, R., Sandborn, W. J., ... Egan, L. J. (2008). Risk Factors for Opportunistic Infections in Patients With Inflammatory Bowel Disease. Gastroenterology, 134(4), 929-936. https://doi.org/10.1053/j.gastro.2008.01.012

Risk Factors for Opportunistic Infections in Patients With Inflammatory Bowel Disease. / Toruner, Murat; Loftus, Jr, Edward Vincent; Harmsen, W. Scott; Zinsmeister, Alan R.; Orenstein, Robert; Sandborn, William J.; Colombel, Jean Frederic; Egan, Laurence J.

In: Gastroenterology, Vol. 134, No. 4, 04.2008, p. 929-936.

Research output: Contribution to journalArticle

Toruner, M, Loftus, Jr, EV, Harmsen, WS, Zinsmeister, AR, Orenstein, R, Sandborn, WJ, Colombel, JF & Egan, LJ 2008, 'Risk Factors for Opportunistic Infections in Patients With Inflammatory Bowel Disease', Gastroenterology, vol. 134, no. 4, pp. 929-936. https://doi.org/10.1053/j.gastro.2008.01.012
Toruner, Murat ; Loftus, Jr, Edward Vincent ; Harmsen, W. Scott ; Zinsmeister, Alan R. ; Orenstein, Robert ; Sandborn, William J. ; Colombel, Jean Frederic ; Egan, Laurence J. / Risk Factors for Opportunistic Infections in Patients With Inflammatory Bowel Disease. In: Gastroenterology. 2008 ; Vol. 134, No. 4. pp. 929-936.
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AB - 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.

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