Medical Clinic I, Gastroenterology, Rheumatology, Infectiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
Dig Dis. 2009;27(4):555-9. doi: 10.1159/000233297. Epub 2009 Nov 4.
Patients with inflammatory bowel disease (IBD) are susceptible to infections.
Independently from immunomodulatory therapy, IBD predisposes to infectious complications. Thus, the incidence of Clostridium difficile infection is increased in IBD patients, and a significant proportion of these patients contracts C. difficile infection outside the hospital and without precedent antibiotic use. Cytomegalovirus infection has been reported in cortico- steroid-naive patients with ulcerative colitis, and infectious gastroenteritis has been linked to initiation and exacerbation of IBD. Finally, in Crohn's disease there is a substantial risk for abscess formation, and urinary tract infections occur more frequently than in a non-IBD control population. Apart from the disease process itself, factors that predispose to infectious complications in IBD are malnutrition, advanced age, immunosuppressive medications, leukopenia from immunosuppressive medications, and surgery. However, the main risk for infections is clearly related to the use of immunosuppressive agents such as corticosteroids, azathioprine, methotrexate, cyclosporine, and TNF-blocking biologicals. A wide spectrum of infectious complications has been reported in patients treated with these medications, including viral (e.g. CMV, VZV, EBV), bacterial (e.g. Mycobacteria, Listeria, staphylococci), fungal (e.g. Pneumocystis jiroveci, Aspergillus, Candida, Cryptococcus) and protozoal (Toxoplasma) pathogens. The greatest risks obviously relate to the combined use of immunomodulating agents rather than to individual drugs. The risk of infections is also aggravated by an insufficient immunization status as frequently observed in patients with IBD.
Physicians treating patients with IBD must be aware of the risk for infectious complications in these patients as well as of strategies to minimize them.
炎症性肠病（IBD）患者易发生感染。
除免疫调节治疗外，IBD 易发生感染并发症。因此，IBD 患者艰难梭菌感染的发病率增加，其中相当一部分患者在院外且无先前使用抗生素的情况下感染艰难梭菌。皮质类固醇初治溃疡性结肠炎患者曾报告有巨细胞病毒感染，感染性胃肠炎与 IBD 的发作和加重有关。最后，在克罗恩病中，脓肿形成的风险很大，尿路感染的发生率高于非 IBD 对照人群。除疾病本身外，易发生感染并发症的 IBD 相关因素包括营养不良、高龄、免疫抑制药物、免疫抑制药物引起的白细胞减少以及手术。然而，感染的主要风险显然与免疫抑制药物的使用有关，如皮质类固醇、硫唑嘌呤、甲氨蝶呤、环孢素和 TNF 阻断生物制剂。这些药物治疗的患者报告了广泛的感染并发症，包括病毒（例如 CMV、VZV、EBV）、细菌（例如分枝杆菌、李斯特菌、葡萄球菌）、真菌（例如肺孢子菌、曲霉、念珠菌、隐球菌）和原生动物（弓形虫）病原体。显然，最大的风险与免疫调节药物的联合使用有关，而不是与单一药物有关。免疫抑制药物治疗的患者常因免疫接种状况不足而加重感染风险，IBD 患者也存在这种情况。
治疗 IBD 患者的医生必须意识到这些患者发生感染并发症的风险，以及尽量减少这些并发症的策略。
