Healthcare Workers with IBD at Higher Risk of Tuberculosis but Not Other Infections, Study Suggests

Healthcare Workers with IBD at Higher Risk of Tuberculosis but Not Other Infections, Study Suggests

Healthcare workers with inflammatory bowel disease (IBD) develop tuberculosis at a higher rate than non-healthcare workers with IBD, but this trend does not extend to other types of severe infection, according to a study.

These results support the importance of screening for tuberculosis in IBD patients who work in healthcare fields.

Researchers also found that exposure to corticosteroids, immunosuppressants, and anti-tumor necrosis factor‐α (TNF) agents increased the risk of serious infections in all IBD patients, independent of their occupations.

The study, “Risk of serious infection in healthcare workers with inflammatory bowel disease: a case‐control study of the GETAID,” was published in the journal Alimentary Pharmacology And Therapeutics.

Healthcare workers, including physicians, nurses, nurses’ aides, and other medical professionals, are at an increased risk of getting severe infections due to their proximity and routine exposure to infected patients and nonsymptomatic carriers.

IBD treatment relies heavily on TNF agents and other immunosupressant therapies. Their effectiveness, however, is counterbalanced by an increased risk of cancer and infections.

The research team evaluated the chances of healthcare workers with IBD developing a severe infection, compared with IBD patients who do not work in healthcare fields. They also determined factors that predict severe infection in the overall IBD population.

The study included 482 French and Belgian healthcare workers with IBD and an equal number of non-healthcare members with IBD as controls.

Healthcare workers with IBD were recruited through the national IBD society of France — GETAID (Groupe d’Etude Thérapeutique des Affections Inflammatoires du tube Digestif). The control patients were selected from the MICISTA registry — a clinical database for patients at Saint Antoine Hospital in Paris.

Participants were at least 18 years old, and the median follow-up period for the study was 9.3 years.

Researchers evaluated the infection incidence rates — overall occurrences of severe infections, defined as any community-acquired (outside the hospital) infections that required hospitalization such as pneumonia, Clostridium difficile and Mycobacterium tuberculosis infections.

In the overall population, 139 severe infection cases were reported, including nine tuberculosis infections, 21 community-acquired pneumonia cases, 30 C. difficile infections, 33 viral infections, and 46 other severe infections that required hospitalization.

A higher number of tuberculosis cases were reported in healthcare workers with IBD (eight events) than in the control population (one event).

For all other infections, no significant difference was noted between the two groups, the team reported.

“These data are reassuring for the daily management of such patients potentially considered at increased risk of exposure to infectious agents and may be extended to professions such as social workers or childcare workers,” the researchers wrote.

Using a statistical measure called odd ratio (OR), the team also assessed the influence of the use of immunosuppressive medications on the occurrence of these severe infections in the entire population. An OR of greater than one indicates an increased likelihood of severe infections.

Patients on anti-TNF therapy (OR 2.93), steroids (OR 3.05), and immunomodulators (OR 1.98) had a higher risk of developing any opportunistic infections, while a history of Crohn’s disease (OR 0.63) lowered its likelihood, the study reported.

Of note, physicians (OR 8), those on steroid therapy (OR 6.17), and those on anti‐TNF therapy (OR 4.62) had an increased risk of developing tuberculosis.

In addition, the chances of community-acquired pneumonia were predominantly higher among patients who were older than 50 (OR 4.69), on anti-TNF therapy (OR 5.1), or on Entyvio (vedolizumab; OR 23.81).

Besides tuberculosis, there was no increased risk of severe infections in healthcare workers with IBD compared with the control group.

“Further studies are warranted to better understand whether immunosuppressive therapy should be administered according to risk stratification based on pathogen exposure in professionals,” the study concluded.