Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Dig Dis Sci. 2020 Nov;65(11):3287-3296. doi: 10.1007/s10620-020-06071-2. Epub 2020 Jan 24.
The advent of PCR-based stool testing has identified a greatly increased number of infectious agents in IBD, but their clinical significance is unknown.
To determine the infectious agent prevalence and the clinical significance of these infectious agents in IBD patients.
This cross-sectional study compared the prevalence of GI infections among IBD patients with active and quiescent disease versus healthy controls. Among actively inflamed patients, we compared clinical characteristics, medication use, and disease course between those with positive and negative tests.
Three hundred and thirty-three IBD patients and 52 healthy volunteers were included. The IBD group was divided into active Crohn's disease (CD, n = 113), inactive CD (n = 53), active ulcerative colitis (UC, n = 128), and inactive UC (n = 39). A significantly higher percentage of actively inflamed patients had positive stool tests (31.1%) compared to those with quiescent disease (7.6%, P = < 0.001) and healthy controls (13.5%, P = 0.01). In actively inflamed patients, shorter symptom duration and the use of multiple immunosuppressive agents were significantly associated with positive stool tests. Escalation of immunosuppressive therapy was less frequent in those with positive (61.3%) than with negative tests (77.7%, P = < 0.01). However, the need for surgery (13.3% vs. 18.7%, respectively, P = 0.31) and hospitalization (14.7% vs. 17.5%, respectively, P = 0.57) in 90 days was not significantly different.
GI infections are common in IBD patients with active disease. Evaluating patients for infection may help avoid unnecessary escalation of immunosuppressants, especially during an acute flare or combination immunosuppression.
基于 PCR 的粪便检测方法发现，在 IBD 患者中存在大量增加的传染性病原体，但它们的临床意义尚不清楚。
确定 IBD 患者中这些传染性病原体的感染率及其临床意义。
本横断面研究比较了活动期和缓解期 IBD 患者与健康对照者之间胃肠道感染的感染率。在炎症活跃的患者中，我们比较了检测结果阳性和阴性患者的临床特征、药物使用和疾病过程。
共纳入 333 例 IBD 患者和 52 名健康志愿者。IBD 组分为活动期克罗恩病（CD，n=113）、缓解期 CD（n=53）、活动期溃疡性结肠炎（UC，n=128）和缓解期 UC（n=39）。与缓解期疾病（7.6%，P<0.001）和健康对照组（13.5%，P=0.01）相比，炎症活跃的患者粪便检测阳性率（31.1%）明显更高。在炎症活跃的患者中，症状持续时间较短和使用多种免疫抑制剂与粪便检测阳性显著相关。与检测结果阴性者（77.7%）相比，检测结果阳性者（61.3%）更频繁地接受免疫抑制剂升级治疗（P<0.01）。然而，在 90 天内需要手术（分别为 13.3%和 18.7%，P=0.31）和住院（分别为 14.7%和 17.5%，P=0.57）的患者无显著差异。
胃肠道感染在活动期 IBD 患者中很常见。评估患者是否存在感染可能有助于避免不必要地升级免疫抑制剂，尤其是在急性发作或联合免疫抑制期间。
