Enteric opportunistic infections in patients with inflammatory bowel disease receiving biologic therapies: a retrospective cohort study.

IF 5 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gut Pathogens Pub Date : 2025-12-21 DOI:10.1186/s13099-025-00793-2

Ting-Chieh Huang, Tony Kou, Chia-Jung Kuo, Cheng-Hsun Chiu, Tai-Di Chen, Chien-Ming Chen, Jen-Wei Chou, Tien-Yu Huang, Chen-Wang Chang, Cheng-Tang Chiu, Ming-Yao Su, Yu-Bin Pan, Puo-Hsien Le

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引用次数: 0

Abstract

Background: Biologic therapy has improved outcomes in inflammatory bowel disease (IBD) but may predispose patients to enteric opportunistic infections. Asian data comparing infection risk across biologic classes remain scarce. We therefore assessed the incidence of Clostridioides difficile infection (CDI), Clostridium innocuum (CI) infection, and cytomegalovirus (CMV) colitis in IBD patients treated with Vedolizumab (VDZ), anti-tumor necrosis factor agents (anti-TNF), or Ustekinumab (UST).

Methods: This single‑center, retrospective cohort study included IBD patients who initiated VDZ, anti‑TNF (infliximab or adalimumab) or UST at Chang Gung IBD Center between January 2017 and December 2024. Opportunistic infection was defined as: (i) toxin‑gene PCR-positive CDI, (ii) CI isolated in stool/colonic culture, or (iii) CMV‑positive immunohistochemistry on intestinal biopsy. Incidence rates were expressed per 100 patient‑years. Infection‑free survival was compared with Kaplan-Meier analysis and log‑rank testing. Multivariable logistic regression identified independent predictors of CDI.

Results: A total of 614 patients (377 Crohn's disease; 237 ulcerative colitis) contributed 941 patient‑years of follow‑up. The incidences per 100 patient-years were 3.51 for CDI, 0.85 for CI, and 3.30 for CMV colitis. CDI and CI risks were comparable across VDZ, anti‑TNF and UST cohorts. CMV colitis was significantly more common with anti‑TNF therapy (5.9%) than with VDZ (3.4%) or UST (0.5%) (p = 0.020). Independent predictors of CDI were an acute IBD flare (odds ratio [OR] 3.64; 95% confidence interval 1.91-6.91), concurrent CMV colitis (OR 6.34; 95% confidence interval 2.03-19.8) and CI infection (OR 7.79; 95% confidence interval 1.40-43.3).

Conclusion: VDZ and UST were not associated with excess CDI, CI or CMV risk, whereas anti‑TNF therapy conferred a higher burden of CMV colitis. Heightened infection surveillance is warranted during acute flares and refractory disease courses.

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接受生物治疗的炎症性肠病患者肠道机会性感染：一项回顾性队列研究

背景：生物治疗改善了炎症性肠病（IBD）的预后，但可能使患者易患肠道机会性感染。亚洲比较不同生物类别感染风险的数据仍然很少。因此，我们评估了使用Vedolizumab （VDZ）、抗肿瘤坏死因子药物（anti-TNF）或Ustekinumab （UST）治疗的IBD患者中艰难梭菌感染（CDI）、无创性梭菌（CI）感染和巨细胞病毒（CMV）结肠炎的发生率。方法：这项单中心、回顾性队列研究纳入了2017年1月至2024年12月在常贡IBD中心接受VDZ、抗TNF（英夫利昔单抗或阿达木单抗）或UST治疗的IBD患者。机会性感染被定义为：(i)毒素基因pcr阳性CDI，（ii）粪便/结肠培养中分离的CI，或（iii）肠道活检中CMV免疫组化阳性。发病率表示为每100例患者年。无感染生存率采用Kaplan-Meier分析和log - rank检验进行比较。多变量logistic回归确定了CDI的独立预测因子。结果：614例患者（377例克罗恩病，237例溃疡性结肠炎）共随访941患者年。CDI的发病率为每100例患者年3.51例，CI为0.85例，CMV结肠炎为3.30例。VDZ组、抗TNF组和UST组的CDI和CI风险具有可比性。抗TNF治疗组CMV结肠炎发生率（5.9%）明显高于VDZ组（3.4%）或UST组（0.5%）（p = 0.020）。CDI的独立预测因子是急性IBD爆发（比值比[OR] 3.64； 95%可信区间1.91-6.91）、并发CMV结肠炎（比值比[OR] 6.34； 95%可信区间2.03-19.8）和CI感染（比值比[OR] 7.79； 95%可信区间1.40-43.3）。结论：VDZ和UST与CDI、CI或CMV风险无关，而抗TNF治疗会增加CMV结肠炎的负担。在急性发作和难治性疾病期间，加强感染监测是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gut Pathogens GASTROENTEROLOGY & HEPATOLOGY-MICROBIOLOGY

CiteScore

7.70

自引率

2.40%

发文量

期刊介绍： Gut Pathogens is a fast publishing, inclusive and prominent international journal which recognizes the need for a publishing platform uniquely tailored to reflect the full breadth of research in the biology and medicine of pathogens, commensals and functional microbiota of the gut. The journal publishes basic, clinical and cutting-edge research on all aspects of the above mentioned organisms including probiotic bacteria and yeasts and their products. The scope also covers the related ecology, molecular genetics, physiology and epidemiology of these microbes. The journal actively invites timely reports on the novel aspects of genomics, metagenomics, microbiota profiling and systems biology. Gut Pathogens will also consider, at the discretion of the editors, descriptive studies identifying a new genome sequence of a gut microbe or a series of related microbes (such as those obtained from new hosts, niches, settings, outbreaks and epidemics) and those obtained from single or multiple hosts at one or different time points (chronological evolution).