Faculty Opinions recommendation of Antibiotic use differentially affects the risk of anti-drug antibody formation during anti-TNFα therapy in inflammatory bowel disease patients: a report from the epi-IIRN.

Author(s):  
Jack Satsangi
Author(s):  
Cristina Canova ◽  
Jonas F Ludvigsson ◽  
Riccardo Di Domenicantonio ◽  
Loris Zanier ◽  
Claudio Barbiellini Amidei ◽  
...  

The role of early-life environmental exposures on Inflammatory Bowel Disease (IBD) onset remains unclear. We aimed to quantify the impact of perinatal conditions and antibiotic use in the first 6 and 12 months of life, on the risk of childhood-onset IBD, in a birth cohort of the region Friuli-Venezia Giulia (Italy). A nested case-control design on a longitudinal cohort of 213,515 newborns was adopted. Conditional binomial regression models were used to estimate Odds Ratios (OR) with 95% confidence intervals (CI) for all analyzed risk factors. We identified 164 individuals with IBD onset before the age of 18 years and 1640 controls. None of the considered perinatal conditions were associated with IBD. Analyses on antibiotic exposure were based on 70 cases and 700 controls. Risks were significantly higher for children with ≥4 antibiotic prescriptions in the first 6 and 12 months of life (OR = 6.34; 95%CI 1.68–24.02 and OR = 2.91; 95%CI 1.31–6.45, respectively). This association was present only among patients with Crohn’s disease and those with earlier IBD onset. We found that perinatal characteristics were not associated to IBD, while the frequent use of antibiotics during the first year of life was associated to an increased risk of developing subsequent childhood-onset IBD.


2020 ◽  
Vol 5 (11) ◽  
pp. 986-995 ◽  
Author(s):  
Long H Nguyen ◽  
Anne K Örtqvist ◽  
Yin Cao ◽  
Tracey G Simon ◽  
Bjorn Roelstraete ◽  
...  

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
William Gillespie ◽  
Neil Marya ◽  
Julien Fahed ◽  
Gregory Leslie ◽  
Krunal Patel ◽  
...  

Aim. To investigate the epidemiology and risk factors of Clostridium difficile infections (CDI) in patients with inflammatory bowel disease (IBD). Methods. This is a retrospective study of patients diagnosed with IBD. 1006 charts were screened and 654 patients met the inclusion criteria. Patients were divided into 2 cohorts based on the presence of prior diagnosis of CDI. Statistical analysis with Pearson’s chi-squared and two-sample t-test was performed. Results. The incidence of CDI among IBD patients was 6.7%. There was equal prevalence of CDI among Crohn’s disease (CD) (n=21, 49%) and ulcerative colitis (UC) (n=22, 51%). IBD patients acquired CDI at a mean age of 42.7 years, with 56% of infections acquired in the community and only 28% associated with healthcare. Only 30% of IBD patients with CDI had prior antibiotic use, and 16% had prior steroid use. IBD patients were significantly more likely to require biologic therapy (57% versus 37%, p<0.01) and have extraintestinal manifestations of IBD (43% versus 28%, p<0.02). Conclusions. IBD patients are more susceptible to CDI at a younger age and often lack traditional risk factors. IBD patients with at least one CDI were more likely to require biologic therapy and had greater rates of extraintestinal manifestations.


2013 ◽  
Vol 24 (4) ◽  
pp. e117-e121 ◽  
Author(s):  
Alon Vaisman ◽  
Kevin Pivovarov ◽  
Allison McGeer ◽  
Barbara Willey ◽  
Bjug Borgundvaag ◽  
...  

BACKGROUND: Patients with inflammatory bowel disease (IBD) experience frequent hospitalizations and use of immunosuppressive medications, which may predispose them to colonization with antimicrobial-resistant organisms (ARO).OBJECTIVE: To determine the prevalence of ARO colonization on admission to hospital and the incidence of infection during hospitalization among hospitalized IBD patients.METHODS: A chart review comparing the prevalence of colonization and incidence of infection with methicillin-resistantStaphylococcus aureus, vancomycin-resistant enterococci and extended-spectrum beta-lactamase-producingEnterobacteriaceae(ESBL) in hospitalized IBD patients with those of non-IBD controls was performed.RESULTS: On admission, there were no significant differences between IBD inpatients and controls in the prevalence of colonization of methicillin-resistantS aureus(1.0% versus 1.2%; P=0.74), vancomycin-resistant enterococci (0.2% versus 0%; P=1.0) or ESBL (4.1% versus 5.5%; P=0.33). Pooling data from historical clinic-based cohorts, IBD patients were more likely than controls to have ESBL colonization (19% versus 6.6%; P<0.05). Antibiotic use on admission was associated with ESBL colonization among IBD inpatients (OR 4.2 [95% CI 1.4 to 12.6]). The incidence of ARO infections during hospitalization was not significantly different between IBD patients and controls. Among IBD patients who acquired ARO infections during hospitalizations, the mean time interval from admission to infection was shorter for those who were already colonized with ARO on admission.CONCLUSIONS: This particular population of hospitalized IBD patients was not shown to have a higher prevalence or incidence of ARO colonization or infection compared with non-IBD inpatients.


2020 ◽  
Vol 26 (9) ◽  
pp. 1436-1442 ◽  
Author(s):  
Hassieb Din ◽  
Alyce J Anderson ◽  
Claudia Ramos Rivers ◽  
Siobhan Proksell ◽  
Filippos Koutroumpakis ◽  
...  

Abstract Background Given the rising prevalence of diabetes mellitus (DM) and the limited data on its effect on the course of inflammatory bowel disease (IBD), we characterized multiyear patterns of disease severity in a cohort of IBD patients with coexistent DM. Methods Data of consented IBD patients followed prospectively in a natural history registry at a tertiary center between 2009 and 2017 were analyzed. Patients with ≥3 years of clinical follow-up were included. Patients identified with a diagnosis of DM were compared with 400 consecutive IBD controls without a diagnosis of DM, no laboratory evidence of hyperglycemia, and no history of antihyperglycemic treatment. Results Out of 2810 IBD patients, 141 (5%) had DM (IBD DM; 44% ulcerative colitis, 56% Crohn’s disease, 48.2% female). IBD DM had higher use of 5-aminosalicylic acid (5ASA) agents (P = 0.04), narcotics (P &lt; 0.001), and antibiotics (P = 0.007) but not immunomodulators and/or biologics compared with IBD controls. When analyzing biomarkers of severity, IBD DM demonstrated higher frequencies of elevated C-reactive protein (CRP; P = 0.006), elevated erythrocyte sedimentation rate (ESR; P = 0.001), eosinophilia (P = 0.004), monocytosis (P = 0.02), and hypoalbuminemia (P = 0.001). IBD DM had worse quality of life (mean Short Inflammatory Bowel Disease Questionnaire; P &lt; 0.001). IBD DM had increased health care utilization compared with controls (emergency room usage P = 0.008, hospitalizations P &lt; 0.001, gastroenterology clinic visits P &lt; 0.001, and median annual charges P &lt; 0.001). Among IBD DM patients, the use of immunomodulators and/or biologics was not associated with further complications as measured by antibiotic use or hospitalizations. Conclusions This study of a large IBD cohort suggests that DM in IBD may be associated with increased disease severity and that there may be room for increasing use of highly effective immunomodulator and/or biologic agents in this group.


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