Clarke Kofi, Amakye Dominic, Shi Jiqing, Dalessio Shannon, DiJoseph Kara, Coates Matthew D
Department of Medicine, Division of Gastroenterology and Hepatology Penn State College of Medicine Hershey Pennsylvania USA.
Department of Internal Medicine Piedmont Athens Regional Medical Center Athens Georgia USA.
Health Sci Rep. 2025 Aug 11;8(8):e71165. doi: 10.1002/hsr2.71165. eCollection 2025 Aug.
Antibiotics are sometimes prescribed as concurrent therapy in the management of acute severe ulcerative colitis (ASUC) with a rationale of treating any presumed concurrent infections. It is unclear if there are data indicating any benefit of this clinical practice. We sought to evaluate the concurrent use of antibiotics with infliximab in patients hospitalized for the treatment of ASUC.
We performed a retrospective cohort study on hospitalized patients with ASUC, comparing the outcomes of patients who received both rescue infliximab and antibiotics to patients who received rescue infliximab without antibiotics. The comparative cohorts were derived from the TriNetX US Collaborative Network. Propensity score matching was used to balance cohorts on baseline demographic and clinical characteristics. Kaplan Meier analyses and hazard ratios with 95% confidence intervals were calculated.
Concurrent administration of antibiotics and antimicrobials with rescue infliximab in ASUC does not result in any benefit in IBD related surgery (HR: 1.18; 95% CI: 0.82-1.70), colectomy (HR: 1.08; 95% CI: 0.54-2.13), sepsis (HR: 1.36; 95% CI: 0.84-2.20) and mortality (HR: 0.81; 95% CI: 0.32-2.05). Furthermore, the antibiotic cohort was more likely to utilize emergency department services (HR: 1.29; 95% CI: 1.02-1.64) and critical care services (HR: 2.36; 95% CI: 1.31-4.24) in the studied outcome time period.
Empiric administration of antibiotics or antimicrobials with infliximab rescue therapy in ASUC does not improve outcomes and may be associated with higher health care utilization.
在急性重症溃疡性结肠炎（ASUC）的治疗中，有时会将抗生素作为联合疗法使用，其依据是治疗任何假定的并发感染。目前尚不清楚是否有数据表明这种临床实践有任何益处。我们试图评估在因ASUC住院治疗的患者中抗生素与英夫利昔单抗的联合使用情况。
我们对住院的ASUC患者进行了一项回顾性队列研究，比较接受挽救性英夫利昔单抗和抗生素治疗的患者与仅接受挽救性英夫利昔单抗而未使用抗生素治疗的患者的结局。比较队列来自TriNetX美国协作网络。使用倾向评分匹配来平衡队列的基线人口统计学和临床特征。计算了Kaplan Meier分析和95%置信区间的风险比。
在ASUC中，抗生素和抗菌药物与挽救性英夫利昔单抗联合使用在与炎症性肠病相关的手术（风险比：1.18；95%置信区间：0.82 - 1.70）、结肠切除术（风险比：1.08；95%置信区间：0.54 - 2.13）、脓毒症（风险比：1.36；95%置信区间：0.84 - 2.20）和死亡率（风险比：0.81；95%置信区间：0.32 - 2.05）方面均未带来任何益处。此外，在研究的结局时间段内，使用抗生素的队列更有可能使用急诊科服务（风险比：1.29；95%置信区间：1.02 - 1.64）和重症监护服务（风险比：2.36；95%置信区间：1.31 - 4.24）。
在ASUC中，经验性地将抗生素或抗菌药物与英夫利昔单抗挽救疗法联合使用并不能改善结局，且可能与更高的医疗保健利用率相关。
