August 03, 2018
2 min read

Tuberculosis risk higher among health care workers with IBD

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Health care workers with inflammatory bowel disease are at higher risk for tuberculosis infection compared with the general inflammatory bowel disease population, according to research presented in Alimentary Pharmacology & Therapeutics.

Charlotte Gagnière, of the department of gastroenterology at Henri Mondor University Hospital in Paris, and colleagues wrote that tuberculosis screening should be weighed in this population, particularly among patients treated with anti-TNF agents.

“Health care workers represent a subgroup of patients exposed to a substantial risk for acquiring incidental infection due to daily and close interactions with infected patients and asymptomatic carriers of pathogens,” they wrote.

Gagnière and colleagues sought to determine the overall risk for severe infection in health care workers with IBD compared with the general IBD population. They conducted a case-control study comprised of 482 health care workers with IBD and 482 controls (non-health care workers with IBD).

The study period ran from the date of diagnosis to June 2016 (mean follow-up = 9.3 years). Investigators defined severe infection as any community-acquired infection that required hospitalization.

During the follow-up period, Gagnière and colleagues identified 139 severe infections among cases and controls, including Clostridium difficile (n = 30), severe viral infections (n = 33), tuberculosis (n = 9), pneumonia (n = 21) and others (n = 46). All 9 patients who developed tuberculosis had been treated with anti-TNF agents.

While they found no significant difference between cases and controls in overall incidence for severe infection (72 events vs. 65 events per 100 patient-semesters), investigators found that the health care workers had an increased risk for developing tuberculosis (8 events vs. 1 event per 100 patient-semesters; P = .02).

Additionally, researchers associated severe infection with current exposure to corticosteroids (OR = 3.05; 95% CI, 2.06–4.52), immunosuppressants (OR = 1.98; 95% CI, 1.38–2.84), and anti-TNF agents (OR = 2.93; 95% CI, 2.02–4.27).

Although they found no increased risk for severe infection among health care workers overall, Gagnière and colleagues wrote that special care should be taken regarding tuberculosis.

“Special attention should be given to healthcare workers with IBD treated with antiTNF based on the potential benefit of periodical screening for latent tuberculosis infection,” they wrote. “Patients with IBD treated with anti-TNF and vedolizumab [Entyvio, Takeda Pharmaceuticals], especially those [older than] 50 years, should receive pneumococcal vaccination.” – by Alex Young

Disclosures: Gagnière reports financial ties to Takeda Pharmaceuticals. Please see the full study for all other authors’ relevant financial disclosures.