Clinical Features Of Infection In Patients With Inflammatory Bowel Diseases On Infliximab Treatment

Objective:Inflammatory Bowel Diseases(IBD)is an autoimmune disease that shows an abnormal immune response in the gastrointestinal tract.Corticosteroids,immunosuppressants and biological agents are the main subjects,inducing IBD remission and maintenance,among which biological agents have sprung up recently.Infliximab(IFX)is a non-selective anti-tumor necrosis factor α(TNF-α)antibody,which can effectively improve the endoscopic remission rate of IBD patients.However,it increases the infection risk of IBD patients with poor immune function and nutritional status because of its immunosuppression.Domestic and international studies have shown that IFX can increase the risk of infection,but there is still a lack of epidemiological data in China.The purpose of this study was to explore the features and related factors of infection events in patients with IBD on IFX treatment.Methods:Patients with IBD received IFX treatment in the Department of Gastroenterology,the First Affiliated Hospital of Dalian Medical University,from July 2013 to October 2020 were admitted retrospectively.The basic data were collected before the first IFX treatment including age,agender,course of disease,diagnosis,Montreal classification,defecation frequency,hematochezia,extraintestinal manifestations of Crohn’s Disease(CD)patients,pulse,body temperature,endoscopic results,HB,ESR,PLT,Total Protein,Albumin,WBC,RBC,Mayo score,CDAI score,Truelove score,smoking history,medication history(treatment of immunosuppressants and corticosteroids before and during IFX treatment),operation history,inflammation index before treatment(ESR,CRP,PLT,WBC,PLT,RBC,HCT),nutritional status index(Albumin,Total Protein,HB),chest CT,type of infection events after IFX treatment,frequency of IFX treatment,clinical index of infection event at the time of infection.Based on the above data,we analyzed the infection incidence,infection type and risk factors related to infection of IBD patients on IFX treatment.Results:(1)A total of 76 patients with IBD were enrolled in this study,among which the incidence of infection events was 22.37%(17/76)and the incidence rate was 18 per 100 patient-years.The incidence of opportunistic infection was 11.84%(9/76),and the incidence of severe infection was10.53%(8/76).The incidence of pneumonia was the highest in infection events,accounting for 41.18%(7/17).(2)Among the 17 patients diagnosed with infection,13(76.47%)patients were re-treated with IFX,4(23.53%)patients changed therapies,and one patient developed bullous pemphigoid,pneumonia and oral Candida albicans infection after re-IFX treatment.Three patients with latent tuberculosis after IFX treatment(3.95%)received anti-tuberculosis treatment before resuming IFX treatment,within a median time of 1.5months.Two patients with active tuberculosis(2.63%)did not continue to receive IFX treatment after anti-tuberculosis treatment.(3)The occurrence of infection events in patients with IBD on IFX treatment was related to the frequency of defecation and the severity of the disease before treating with IFX.The occurrence of infection events in patients with ulcerative colitis(UC)was correlated with defecation frequency,Mayo score,the severity of the disease assessed with Mayo score system and degree of hematochezia before treating with IFX,but infection events in CD patients were not correlated with clinical characteristic index.(4)The disease severity in patients with IBD before treating was an independent risk factor of infection on IFX treatment(OR=3.937,95%CI(1.105,14.031),P= 0.035).Conclusion:(1)IFX treatment increase the risk of infection in patients with IBD,especially the risk of pneumonia.(2)The occurrence of infection events in IBD patients was related to the frequency of defecation and the severity of the disease before IFX treatment,and the occurrence of infection events in patients with UC was related to the frequency of defecation,Mayo score,the severity of the disease through Mayo score system and the degree of hematochezia before IFX treatment.(3)The disease severity is an independent risk factor of infection in patients with IBD on IFX treatment.