Source:
Investigators from multiple institutions conducted a retrospective study to assess the risk of serious infections in children with inflammatory bowel disease (IBD) compared to the general population. For the study, children <18 years old, diagnosed with IBD between 2002–2017 were identified through the Swedish Patient Registry using ICD codes or by reviewing colorectal histopathology data from a national registry. Children with IBD were further classified as having ulcerative colitis (UC), Crohn’s disease (CD), or IBD unclassified (IBD-U) based on ICD codes. Using data in the Swedish Total Population Register, each child with IBD was matched on age, sex, birth year, and place of residence with up to 10 controls without IBD.
The primary study outcome was serious infection, defined as an infection requiring inpatient hospital care and identified using ICD codes. Infections were divided into several categories, including location (respiratory, gastrointestinal, urinary tract, other), sepsis, opportunistic, organism (eg, Clostridium difficile), and vaccine-preventable. Occurrence of serious infection in the year following bowel and perianal surgery also was assessed. Children with IBD and controls were followed from time of diagnosis until diagnosis of first serious infection, emigration, death, their 18th birthday, or end of the study period. Cox regression was used to compare the risk (hazard ratio [HR]) of serious infection in those with IBD to that of controls, after adjusting for matching variables. Multiple subgroup analyses also were performed.
Data were analyzed on 5,766 children with IBD (2,364 with CD, 2,287 UC, and 1,115 IBD-U) and 58,418 controls. Median age at diagnosis of IBD was 15 years, with 5.3% diagnosed before 6 years of age. A total of 672 serious infections occurred in IBD patients (38.6/1,000 person-years) compared to 778 infections in controls (4.0/1,000 person years; HR, 9.46; 95% CI, 8.53, 10.50). The risk of infection was increased in those with UC (HR, 8.48; 95% CI, 7.21, 9.98), CD (HR, 9.3; 95% CI, 7.86, 11.00), and IBD-U (HR, 12.1; 95% CI, 9.66, 15.10). Overall, the risk of serious infection in children with IBD was highest in the first year of follow-up (HR, 12.6), falling to a 4.8-fold increased risk beyond 10 years of follow-up. Risk of serious infection was also high following bowel or perianal surgery (HR, 17.1 and 10.6, respectively). The risk of serious infection in those with IBD was significantly higher than that of controls in each location assessed, especially gastrointestinal (HR, 31.8; 95% CI, 25.6, 39.3). Opportunistic (HR, 11.8), sepsis (HR, 26.1), C. difficile (HR, 42.2), and vaccine-preventable (HR, 23.6), infections were all significantly more common in children with IBD.
The authors conclude that children with IBD were at increased risk for serious infections requiring hospitalization.
Dr Rosenthal has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an...
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