Adverse Clinical Outcomes among Inflammatory Bowel Disease Patients Treated for Urinary Tract Infection.

Offir Ukashi,Shomron Ben-Horin,Uri Kopylov,Yiftach Barash,Eyal Klang,Tal Zilberman,Bella Ungar,Ido Veisman

doi:10.3390/jcm11051359

Offir Ukashi, Shomron Ben-Horin + Show 6 more

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https://doi.org/10.3390/jcm11051359

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Abstract

Background: Urinary tract infection (UTI) is the most common urologic complication among patients with inflammatory bowel disease (IBD). However, data regarding UTI outcomes in this population are scarce. We aimed to evaluate adverse outcomes of UTI among patients with IBD. Methods: This was a retrospective cohort study of consecutive adult patients who visited the emergency room (ER) at Sheba Medical Center due to a UTI between 2012 and 2018. Data included demographic and clinical variables. UTI cases were extracted using ICD-10 coding. Results: Of 21,808 (ER) visits with a UTI, 122 were IBD patients (Crohn’s disease—52, ulcerative colitis—70). Contrary to non-IBD subjects, patients with IBD had higher rates of hospitalization, acute kidney injury (AKI) and 30 day-recurrent hospitalization (59.3% vs. 68.9%, p = 0.032; 4.6% vs. 13.9%, p < 0.001; 7.3% vs. 15.6%, p = 0.001, respectively). Among patients with IBD, advanced age (p = 0.005) and recent hospitalization (p = 0.037) were associated with increased risk for hospitalization, while hydronephrosis (p = 0.005), recent hospitalization (p = 0.011) and AKI (p = 0.017) were associated with increased 30-day recurrent hospitalization. Neither immunosuppressants nor biologics were associated with UTI outcomes among patients with IBD. Conclusions: Patients with IBD treated for a UTI had higher rates of hospitalization, AKI and 30-day recurrent hospitalization than non-IBD patients. No association was observed between immunosuppressants or biologics and UTI outcomes.

Highlights

Inflammatory bowel disease (IBD) mainly encompasses two chronic inflammatory states primarily affecting the gastrointestinal (GI) tract: Crohn’s disease (CD) and ulcerative colitis (UC) [1,2]
122 patients had a previous diagnosis of inflammatory bowel disease (IBD) (CD—52, 52, UC—70), while there were 21,686 non-IBD patients (Figure 1)
11.067, 95% confidence interval (CI) 1.161–105.471, p = 0.037) to be independently associated with increased risk of hospitalization among patients with IBD treated for Urinary tract infection (UTI)

Summary

Introduction

Inflammatory bowel disease (IBD) mainly encompasses two chronic inflammatory states primarily affecting the gastrointestinal (GI) tract: Crohn’s disease (CD) and ulcerative colitis (UC) [1,2]. The incidence of IBD in Western countries is stable and even falling, and the prevalence is estimated at 0.3% [3]. There is a rising rate of IBD incidence in newly industrialized countries. Overall, the incidence and prevalence of IBD are increasing worldwide [2,3]. Considering the inflammatory nature of the disease, many agents used for IBD treatment alter immune system activity and potentially increase infection risk and infectious complications [5]. Based on genome-wide association studies, the innate immune system might be impaired in IBD patients [5]. Urinary tract infection (UTI) is the most common urologic complication among patients with inflammatory bowel disease (IBD). Data regarding UTI outcomes in this population are scarce. We aimed to evaluate adverse outcomes of UTI among patients with.

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