Introduction The European Crohn's and Colitis Organisation (ECCO) has recently published recommendations on screening and prevention of opportunistic infections in inflammatory bowel disease (IBD) patients. These are based on expert opinion and available evidence, and are more extensive than previous guidelines. The aim of this audit is to compare current practice of screening for, and prevention of, opportunistic infections in our IBD clinic, with these recommendations, and to examine the implications of following the guidelines.
Methods IBD patients at risk of opportunistic infections (as defined by ECCO; those treated with thiopurines, methotrexate, anti-TNF or prednisolone>20 mg daily for >2 weeks) were selected consecutively from our IBD clinic and infliximab infusion service from July to November 2009. A data collection sheet was completed for each patient by direct questioning in clinic and by review of patients' records. Information collected included; demographic and clinical details, immunosuppressive medication (IM), screening tests performed (HBsAg, anti-HBs, antiHBc, HCVAb, HIVAb, VZVAb (not applicable (n/a) if history of VZV infection), CXR and cervical smear (females)), and vaccinations given prior to treatment (Hepatits B, VZV (n/a if history of VZV infection), HPV (women<26 years), influenza and Streptococcus pneumoniae). A cost analysis of this screening and vaccination strategy was performed.
Results Ninety patients (Crohn's disease (n=70), Ulcerative Colitis (n=19), IBD-unclassified (n=1)) were audited to the time of abstract submission. Of these, 46 were male and 44 female (median age 32 years). Forty-one percent of patients were taking thiopurine monotherapy, 34% concomitant thiopurine and anti-TNF therapy, 14% anti-TNF monotherapy, 6% prednisolone, and 5% methotrexate. The proportion of patients who had recommended screening tests and vaccinations are shown in the table. Patients on anti-TNF therapy were more likely to have undergone CXR, hepatitis B and C screening (p<0.05). The cost of these screening tests and vaccinations (excluding HPV) was GBP£255 per patient (equipment and manpower costs not included) (Abstract 032).
Conclusion Our current practice of screening for and prevention of opportunistic infections in at-risk IBD patients is not in line with recent ECCO recommendations. However, some of the ECCO recommendations are based on limited evidence. Therefore, ongoing audit and research, as well as proof of cost benefit, may be required before they gain widespread acceptance.
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