Search in the Abstract Database

Search Abstracts 2011

* = Presenting author

P381. The impact of intestinal infections in IBD patients: Experience from an Italian tertiary referral centre

E. Antonelli1, M. Baldoni1, G. Casella2, V. Villanacci3, G. Bassotti1

1Gastro­enterologia, Perugia, Italy; 2Gastro­enterologia, Desio, Italy; 3Pathology, Brescia, Italy

Aim: Intestinal infections may precipitate or aggravate inflammatory bowel disease (IBD) flares. The reported incidence of intestinal infections among IBD patients varies between 9 and 13%, but during the last years an increase of these infections in such patients has been documented. The aim of our study was to evaluate the incidence of intestinal infections in IBD patients hospitalised in a tertiary referral centre.

Materials and Methods: Data of all IBD in-patients treated between June 2007 and June 2010 for an acute flare at the Gastroenterology Section of Santa Maria della Misericordia Hospital, University of Perugia, were analysed. Intestinal superinfections in this cohort were assessed by stool samples (culture for bacteria, viruses, parasites, and toxins for Clostridium difficile) or by histopathology, including immunohistochemistry (IHC), antigenemia and quantitative real-time PCR in inflamed colonic tissue or blood for CMV. Of the infected IBD patients the following demographic and clinical variables were considered: age, sex, anatomical distribution of disease. Further potential risk factors (previously antibiotics use or hospitalisation and IBD-related treatment) were also examined. CPR values of all patients were also available

Results: Overall, data from 113 patients, 54 Ulcerative Colitis (25 female, 29 male) and 59 Crohn's disease (31 female, 28 male) were available for analysis. During the study period intestinal infections were demonstrated in 13.2% patients. Bacteriological analysis revealed Campylobacter jejuni (n = 2 CD, 1 = UC), Clostridium difficile (n = 6 UC, n = 1CD), CMV (n = 7 UC). Median age was 34.5 years (25–55 IC 95%) in CU/Clostridium group, 41 years (19–64 IC 95%) in CU/CMV group, and 47 (25–70 IC 95%) in CD/Campylobacter group. Concerning UC, infected patients all had left side colitis or pancolitis, while in CD infected patients, 1 had colonic disease, 1 ileocolonic disease and 1 jejuno-ileal disease. Median CPR values were 4.9 mg/dl (0.1–16 IC 95%) in CU/Clostridium group, 4.4 mg/dl (0.4–8–4 IC 95%) in CU/CMV group, and 8 mg/dl (0.1–16 IC 95%) in CD/Campylobacter group. Analysing the potential risk factors in Clostridium difficile group, 28% patients had been treated with antibiotics and 50% with steroids and/or immunosuppressors but none with anti-TNFα. CMV infection was detected only in CU patients and 47% of them were on steroids or immunosuppressors but none had been treated with biological therapy. Notably, none of the infected UC patients underwent colectomy.

Conclusions: Considering that the best way to ultimately treat IBD relies on identifying an etiological agent, to define the impact of infection in these patients seems to be relevant to target prevention or develop an effective therapeutic approach.