Screening for Opportunistic Infections in Immunosuppression for Inflammatory Bowel Disease

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Introduction

With inward migration to Northern Ireland increasing, the prevalence of many opportunistic infections is likely to change. Updated guidelines on opportunistic infections in inflammatory bowel disease (IBD) were published by the European Crohn’s and Colitis Organisation in 2014. We set out to assess adherence to these guidelines in fifty patients with IBD before commencing biological therapy.

Fifty sequential patients starting biological therapies were identified and their medical records were reviewed.

Over 80% of patients were appropriately screened for tuberculosis, hepatitis B, hepatitis C and HIV but HBVcore antibody levels were uncommonly checked (22%). Varicella zoster serological (VZVIgG) screening seemed high at 60% but documentation of previous exposure was suboptimal. EBV screening was sporadic with only 20% being checked. Serum and tissue cytomegalovirus testing was performed in most cases of UC but with debate continuing on the optimum approach to this, it was inconsistent. Many of these tests were undertaken as biological therapy approached.

Prophylaxis for PJP infection in patients who receive ‘triple therapy’ was poor with 0 of 9 patients prescribed cotrimoxazole.

Screening was largely in keeping with guidelines but HBV core antibody testing could be improved. The proximity of screening tests to commencing biological therapy leaves little room for intervention. Improvement in antibiotic prophylaxis for PJP is an urgent requirement. We believe better practice could be achieved with improved clinical documentation and by using standardised request forms.