P817 Incidence and risk factors of infection in patients with inflammatory bowel disease: longitudinal prospective INFEII registry of GETECCU
Authors: Zabana Y , Rodríguez-Lago I , Sicilia B , de Francisco R , Piqueras M , de Castro L , Chaparro M , Gomollón F , Domènech E , Llaó J , Márquez-Mosquera L , Lucendo A , García-Bosch O , Calvet X , Gordillo J , Busquets D , Morales V , Rivero M , Guardiola J , Navarro P , Iglesias E , Iborra M , Ferreiro-Iglesias R , Mesonero F , Sesé E , Vicente R , Pajares R , Algaba A , Benítez O , Aceituno M , Rodríguez-Pescador A , Arias-García L , Riestra S , Mena R , Sanromán L , Gisbert J P , Arroyo M T , Mañosa M , Sáinz E , Esteve M ,   GETECCU-INFEII group
Published: January 2024

Abstract

Background
The true effect of having IBD in the development of infections has not been studied in depth since cohort studies are scarce and the results of studies are sometimes contradictory. Especially, this complication has not been addressed prospectively in an incident cohort of patients with IBD.

Aims
To assess, regarding infections in IBD: 1) incidence and type, 2) risk factors, 3) effect of type and the duration of IBD treatment, 4) impact in mortality 5) effect of IBD activity.

Methods
The INFEII registry (ClinicalTrials.gov: NCT02904590) is a prospective study promoted by GETECCU to determine the incidence and risk factors of infection in an inception cohort of patients with IBD and follow-up of at least 5 years. This longitudinal prospective study within the ENEIDA registry was conducted including incident cases with IBD. Patients were recruited between 2016 and 2020 with a planned follow-up of 5 years. All infections were detailed analysed. An infection was considered relevant when: 1) required hospital admission, 2) led to death or endangered the patient’s life, 3) was treated with specific antibiotics,4) occurred recurrently, and/or 5) required change/withdrawal of immunosuppressive treatment.

Results
The INFEII registry recruited 1456 patients from 28 centres throughout Spain. The median follow-up was 71 months (IQR 60-79 months). The description of the cohort is presented in Table 1. Of the 1456 patients included, 580 (40%) presented at least one relevant infection. In total, 1321 infections were collected. One-hundred and seven infections (8%) required hospitalisation and four patients died (0.3%) over infection. Ninety-nine patients were lost to follow-up (22 died and 34 changed hospitals). The most prevalent infections were: ear-nose-throat in 238 cases, urinary tract infections in 237, respiratory in 234, COVID-19 in 133, skin infections in 127, dental in 64 and colitis/enteritis in 64 (Figure 1). From the whole cohort and at some point, in time, 756 (52%) patients received 5ASA, 481 (33%) steroids (369 (25%) oral, 112 (7.7%) intravenous), 568 (39%) azathioprine, 72 (4.9%) methotrexate, 21 (1.4%) tofacitinib, 533 (37%) antiTNF, 141 (9.9%) ustekinumab and 77 (5.3%) vedolizumab. The effect of treatment and IBD activity in each infection is being analysed.

Conclusion
Infections are frequent complications in patients with IBD, presented in 40% of them. Being a woman, having a history of past serious infections or occupational risk may be associated with infection occurrence. It has to be determined if IBD activity and treatment suppose a greater risk for infections. This is a paradigmatic study that implies the first use of the ENEIDA registry in prospective research.