Service d'Hépatogastroentérologie, CHU Mont-Godinne, Yvoir, Belgium.
Dig Dis. 2012;30(4):408-14. doi: 10.1159/000338143. Epub 2012 Jul 12.
In an era of increasing use of immunomodulating therapy and biologics, opportunistic infections have emerged as a pivotal safety concern for patients with IBD. Clinical studies, registries and case reports warn of the increased risk of infection, particularly opportunistic infections. The current challenge to physicians lies not only in managing IBD, but also in recognizing, preventing and treating common and uncommon infections. The European Crohn's and Colitis Organization (ECCO) guidelines on the management and prevention of opportunistic infections in patients with IBD provide clinicians with guidance on the prevention, detection and management of such infections. The proposals therein may appear radical, potentially changing current practice, but we believe that these recommendations will help optimize patient outcome by reducing the morbidity and mortality related to these infections. In this ongoing process, prevention is by far the most important step; this relies on the recognition of risk factors for infection, the use of primary or secondary chemoprophylaxis, careful monitoring (clinical and laboratory work-up) before and during use of immunomodulators and the vaccination and education of the patient. Special recommendations should also be given to patients before and after travelling. Management of infection in IBD patients is case-dependent. Severe infection should be treated according to advice from infectious-disease experts.
在免疫调节治疗和生物制剂日益广泛应用的时代，机会性感染已成为 IBD 患者的一个关键安全问题。临床研究、登记和病例报告警告称感染风险增加，特别是机会性感染。目前，医生面临的挑战不仅在于治疗 IBD，还在于识别、预防和治疗常见和不常见的感染。欧洲克罗恩病和结肠炎组织（ECCO）关于 IBD 患者机会性感染管理和预防的指南为临床医生提供了关于此类感染的预防、检测和管理的指导。其中的建议可能看起来激进，可能会改变当前的实践，但我们相信这些建议将通过减少与这些感染相关的发病率和死亡率来帮助优化患者的预后。在这个持续的过程中，预防是最重要的一步；这依赖于对感染危险因素的认识、使用初级或次级化学预防、在使用免疫调节剂之前和期间进行仔细监测（临床和实验室检查）以及对患者进行疫苗接种和教育。在旅行前后也应向患者提供特别建议。IBD 患者感染的管理取决于具体情况。严重感染应根据传染病专家的建议进行治疗。
