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P267. Opportunistic infection in inflammatory bowel disease: The value of implementing ECCO guidance


C. Glen1, I. Arnott2

1University of Edinburgh, Edinburgh, United Kingdom; 2Western General Hospital, GI Unit, Edinburgh, United Kingdom



Background: Over the past decade the management of inflammatory bowel disease has been revolutionised by the use of anti-TNFα agents. However a concern remains over patient safety. Recent ECCO guidance recommends the screening and immunisation of IBD patients to prevent opportunistic infections.

The aim of this study was to evaluate the frequency of opportunistic infections in patients treated with anti-TNFα compared to those treated with thiopurine and to assess the value of implementing this recent guidance.

Methods: A total of 118 patients receiving anti-TNFα were identified at the Western General Hospital, Edinburgh. 38 patients were taking anti-TNFα plus another form of immunomodulator.

As a control 94 patients taking Azathioprine as a sole form of immunosupression were identified.

Demographic, clinical and treatment data were collected together with the frequency, type and severity of OI. Data were collected retrospectively using hospital electronic records.

Results: A total of 77 infectious events (39.8%) occurred in patients treated with anti-TNFα agents compared to 14 events (13.9%) in those receiving Azathioprine (p < 0.001). Infections experienced were also shown to be more severe in the group receiving anti-TNFα therapy as 13% required in-patient therapy compared to none receiving Azathioprine (p < 0.001).

Infections recorded included bacterial, viral and fungal. These included urinary tract infections, upper/lower respiratory tract infections, gastroenteritis, skin infections, septicaemia, VZV, EBV and influenza H1N1. Only 6% of infections recorded were preventable through screening and immunisation of all patients with IBD.

Conclusions: Opportunistic infections are more common in anti-TNFα treated patients than those on thiopurine alone.

A vaccination protocol has been developed for use at the WGH in accordance with ECCO guidelines but this study shows that implementation of this protocol would have prevented very few (6%) of infections that occurred in this patient cohort.