Abstract
Purpose
The high incidence of infectious complications in ulcerative colitis (UC) is generally recognized to be due to several factors related to a compromised host. In our previous study, a high dose of corticosteroid was shown to be a risk factor for surgical site infection (SSI). Recently, infliximab (IFX) has been used for refractory UC. In this study, the effect of IFX on the occurrence of infectious postoperative complications for UC was evaluated, because it remains controversial.
Method
A total of 196 UC patients who underwent laparotomy between January 2010 and September 2012 were included. Possible factors related to complications were analyzed to identify significant predictors.
Results
Twenty-two patients had IFX before surgery. The overall incidence of SSI was 47/196 (24.0 %). The incidence of infections, including SSI and other infections, was 69/196 (35.2 %). On multivariate analysis, national nosocomial infection surveillance (NNIS) risk index ≥2 (p<0.01) and preoperative prednisolone dose ≥0.2 mg/kg/day (p = 0.01) were identified as independent risk factors for overall SSI; NNIS risk index ≥2 (p <0.01) and duration from onset of UC ≥6.3 years (p = 0.045) were identified as independent risk factors for incisional SSI; contaminated wound class (p <0.01), preoperative hospital stay ≥6 days (p = 0.048), severe/fulminant disease activity (p = 0.04), and pancolitis (p = 0.02) were identified as independent risk factors for organ/space SSI; and contaminated wound (p < 0.01), severe/fulminant disease activity (p = 0.02), and age at surgery ≥43 years (p = 0.047) were identified as independent risk factors for total infectious complications.
Conclusion
IFX administration was not associated with infectious complications for UC surgery.
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References
Langholz E, Munkholm P, Davidsen M, Binder V (1992) Colorectal cancer risk and mortality in patients with ulcerative colitis. Gastroenterology 103:1444–1451
Rutgeerts P, Sandborn WJ, Feagan BG, Reinisch W, Olson A, Johanns J, Travers S, Rachmilewitz D, Hanauer SB, Lichtenstein GR, de Villiers WJ, Present D, Sands BE, Colombel JF (2005) Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med 353:2462–2476
Yamamoto S, Nakase H, Matsuura M, Honzawa Y, Masuda S, Inui K, Chiba T (2010) Efficacy and safety of infliximab as rescue therapy for ulcerative colitis refractory to tacrolimus. J Gastroenterol Hepatol 25:886–891
Colombel JF, Loftus EV Jr, Tremaine WJ, Pemberton JH, Wolff BG, Young-Fadok T, Harmsen WS, Schleck CD, Sandborn WJ (2004) Early postoperative complications are not increased in patients with Crohn’s disease treated preoperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol 99:878–883
Parsi MA, Achkar JP, Richardson S, Katz J, Hammel JP, Lashner BA, Brzezinski A (2002) Predictors of response to infliximab in patients with Crohn's disease. Gastroenterology 123:707–713
Marchal L, D'Haens G, Van Assche G, Vermeire S, Noman M, Ferrante M, Hiele M, Bueno De Mesquita M, D'Hoore A, Penninckx F, Rutgeerts P (2004) The risk of post-operative complications associated with infliximab therapy for Crohn’s disease: a controlled cohort study. Aliment Pharmacol Ther 19:749–754
Selvasekar CR, Cima RR, Larson DW, Dozois EJ, Harrington JR, Harmsen WS, Loftus EV Jr, Sandborn WJ, Wolff BG, Pemberton JH (2007) Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg 204:956–962
Mor IJ, Vogel JD, da Luz MA, Shen B, Hammel J, Remzi FH (2008) Infliximab in ulcerative colitis is associated with an increased risk of postoperative complications after restorative proctocolectomy. Dis Colon Rectum 51:1202–1210
Ehteshami-Afshar S, Nikfar S, Rezaie A, Abdollahi M (2011) A systematic review and meta-analysis of the effects of infliximab on the rate of colectomy and post-operative complications in patients with inflammatory bowel disease. Arch Med Sci 6:1000–1012
Yang Z, Wu Q, Wu K, Fan D (2010) Meta-analysis: pre-operative infliximab treatment and short-term post-operative complications in patients with ulcerative colitis. Aliment Pharmacol Ther 31:486–492
Uchino M, Ikeuchi H, Matsuoka H, Tsuchida T, Tomita N, Takesue Y (2010) Risk factors associated with surgical site infection after ileal pouch-anal anastomosis in ulcerative colitis. Dis Colon Rectum 53:143–149
Cornillie F, Shealy D, D'Haens G, Geboes K, Van Assche G, Ceuppens J, Wagner C, Schaible T, Plevy SE, Targan SR, Rutgeerts P (2001) Infliximab induces potent anti-inflammatory and local immunomodulatory activity but no systemic immune suppression in patients with Crohn's disease. Aliment Pharmacol Ther 15:463–473
Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13:606–608
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections. Am J Infect Control 16:128–140
Truelove SC, Witts LJ (1955) Cortison in ulcerative colitis. Final report on a therapeutic trial. Br Med J 2:1041–1045
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections. Am J Infect Control 16:128–140
Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36:309–332
Sandborn WJ, Loftus EV (2004) Balancing the risks and benefits of infliximab in the treatment of inflammatory bowel disease. Gut 53:780–782
Colombel JF, Loftus EV Jr, Tremaine WJ, Pemberton JH, Wolff BG, Young-Fadok T, Harmsen WS, Schleck CD, Sandborn WJ (2004) Early postoperative complications are not increased in patients with Crohn's disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol 99:878–883
den Broeder AA, Creemers MC, Fransen J, de Jong E, de Rooij DJ, Wymenga A, de Waal-Malefijt M, van den Hoogen FH (2007) Risk factors for surgical site infections and other complications in elective surgery in patients with rheumatoid arthritis with special attention for anti-tumor necrosis factor: a large retrospective study. J Rheumatol 34:689–695
Selvasekar CR, Cima RR, Larson DW, Dozois EJ, Harrington JR, Harmsen WS, Loftus EV Jr, Sandborn WJ, Wolff BG, Pemberton JH (2007) Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg 204:956–962
Mor IJ, Vogel JD, da Luz MA, Shen B, Hammel J, Remzi FH (2008) Infliximab in ulcerative colitis is associated with an increasing risk of postoperative complications after restorative proctocolectomy. Dis Colon Rectum 51:1201–1210
Ehteshami-Afshar S, Nikfar S, Rezaie A, Abdollahi M (2011) A systematic review and meta-analysis of the effects of infliximab on the rate of colectomy and post-operative complications in patients with inflammatory bowel disease. Arch Med Sci 6:1000–1012
Cornillie F, Shealy D, D'Haens G, Geboes K, Van Assche G, Ceuppens J, Wagner C, Schaible T, Plevy SE, Targan SR, Rutgeerts P (2001) Infliximab induces potent anti-inflammatory and local immunomodulatory activity but no systemic immune suppression in patients with Crohn's disease. Aliment Pharmacol Ther 15:463–473
Lim M, Sagar P, Abdulgader A, Thekkinkattil D, Burke D (2007) The impact of preoperative immunomodulation on pouch-related septic complications after ileal pouch-anal anastomosis. Dis Colon Rectum 50:943–951
Ahn HS, Lee SK, Kim HJ, Jang JY, Joo KR, Dong SH, Kim BH, Lee JI, Chang YW, Chang R (2006) Risk of postoperative infection in patients with inflammatory bowel disease. Korean J Gastroenterol 48:306–312
Miki C, Ohmori Y, Yoshiyama S, Toiyama Y, Araki T, Uchida K, Kusunoki M (2007) Factors predicting postoperative infectious complications and early induction of inflammatory mediators in ulcerative colitis patients. World J Surg 31:522–529
Subramanian V, Pollok RC, Kang JY, Kumar D (2006) Systematic review of postoperative complications in patients with inflammatory bowel disease treated with immunomodulators. Br J Surg 93:793–799
Petrosillo N, Drapeau CM, Nicastri E, Martini L, Ippolito G, Moro ML et al (2008) Surgical site infections in Italian hospitals: a prospective multicenter study. BMC Infect Dis 8:34
Edwards JP, Ho AL, Tee MC, Dixon E, Ball CG (2012) Wound protectors reduce surgical site infection: a meta-analysis of randomized controlled trials. Ann Surg 256:53–59
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Uchino, M., Ikeuchi, H., Matsuoka, H. et al. Infliximab administration prior to surgery does not increase surgical site infections in patients with ulcerative colitis. Int J Colorectal Dis 28, 1295–1306 (2013). https://doi.org/10.1007/s00384-013-1700-2
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DOI: https://doi.org/10.1007/s00384-013-1700-2