Impact of Biologics and Proton Pump Inhibitors on Gastrointestinal Infection Risk in Inflammatory Bowel Disease Patients: A Retrospective Analysis of Pathogen-Specific Outcomes and Treatment Interactions
<b>Background/Objectives</b>: Inflammatory bowel disease (IBD) patients face elevated gastrointestinal (GI) infection risks due to immune dysregulation and gut dysbiosis. While steroids and immunosuppressants are known to increase infection risk, data on biologics and proton pump inhibit...
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2025-07-01
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| author | Ryan Njeim Elie Moussa Chapman Wei Joelle Sleiman Reem Dimachkie Liliane Deeb |
| author_facet | Ryan Njeim Elie Moussa Chapman Wei Joelle Sleiman Reem Dimachkie Liliane Deeb |
| author_sort | Ryan Njeim |
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| description | <b>Background/Objectives</b>: Inflammatory bowel disease (IBD) patients face elevated gastrointestinal (GI) infection risks due to immune dysregulation and gut dysbiosis. While steroids and immunosuppressants are known to increase infection risk, data on biologics and proton pump inhibitors (PPIs) remain limited, particularly for non-Clostridioides difficile (C.diff) infections. <b>Methods</b>: This retrospective cohort study analyzed 9849 hospitalized IBD patients (2013–2023) from the Northwell Inpatient Database. Patients were categorized into four groups: biologics-only, PPIs-only, both, or neither. GI infections were identified via C.diff PCR, GI PCR, and chart review. Multivariate logistic regression adjusted for demographics, BMI, and IBD type. <b>Results</b>: GI infections occurred in 1.75% of patients, with significantly higher odds in those on biologics alone (OR 21.5, 95% CI 11.7–39.4) or with PPIs (OR 16.6, 95% CI 10.2–26.8) versus untreated patients. Non-C.diff infections were strongly associated with biologics (OR 20.7, 95% CI 10.2–41.9). PPIs alone increased slightly the risk of GI infections (OR 1.6, 95% CI 1.1–2.4). Vedolizumab and adalimumab had the highest infection risks among biologics (26.8% and 22.7%, respectively). Bacterial pathogens, such as <i>E. coli</i> and <i>Salmonella</i>, predominated, with no significant difference in causative agents across treatment groups. <b>Conclusions</b>: Biologic therapy greatly increases GI infection risk in IBD patients independent of PPI use. Clinicians should weigh infection risks when prescribing biologics, particularly in high-risk populations. Further studies are needed to assess risks by biologic subtype and the interplay with PPIs. |
| format | Article |
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| institution | DOAJ |
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| language | English |
| publishDate | 2025-07-01 |
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| series | Biomedicines |
| spelling | doaj-art-697372ddfc3545658fb23510cdfddc612025-08-20T03:04:42ZengMDPI AGBiomedicines2227-90592025-07-01137167610.3390/biomedicines13071676Impact of Biologics and Proton Pump Inhibitors on Gastrointestinal Infection Risk in Inflammatory Bowel Disease Patients: A Retrospective Analysis of Pathogen-Specific Outcomes and Treatment InteractionsRyan Njeim0Elie Moussa1Chapman Wei2Joelle Sleiman3Reem Dimachkie4Liliane Deeb5Department of Medicine, Staten Island University Hospital, Staten Island, NY 10305, USADepartment of Medicine, Staten Island University Hospital, Staten Island, NY 10305, USADepartment of Medicine, Staten Island University Hospital, Staten Island, NY 10305, USADepartment of Medicine, Staten Island University Hospital, Staten Island, NY 10305, USADepartment of Medicine, Division of Gastroenterology and Hepatology, Northwell Staten Island University Hospital, Staten Island, NY 10305, USADepartment of Medicine, Division of Gastroenterology and Hepatology, Northwell Staten Island University Hospital, Staten Island, NY 10305, USA<b>Background/Objectives</b>: Inflammatory bowel disease (IBD) patients face elevated gastrointestinal (GI) infection risks due to immune dysregulation and gut dysbiosis. While steroids and immunosuppressants are known to increase infection risk, data on biologics and proton pump inhibitors (PPIs) remain limited, particularly for non-Clostridioides difficile (C.diff) infections. <b>Methods</b>: This retrospective cohort study analyzed 9849 hospitalized IBD patients (2013–2023) from the Northwell Inpatient Database. Patients were categorized into four groups: biologics-only, PPIs-only, both, or neither. GI infections were identified via C.diff PCR, GI PCR, and chart review. Multivariate logistic regression adjusted for demographics, BMI, and IBD type. <b>Results</b>: GI infections occurred in 1.75% of patients, with significantly higher odds in those on biologics alone (OR 21.5, 95% CI 11.7–39.4) or with PPIs (OR 16.6, 95% CI 10.2–26.8) versus untreated patients. Non-C.diff infections were strongly associated with biologics (OR 20.7, 95% CI 10.2–41.9). PPIs alone increased slightly the risk of GI infections (OR 1.6, 95% CI 1.1–2.4). Vedolizumab and adalimumab had the highest infection risks among biologics (26.8% and 22.7%, respectively). Bacterial pathogens, such as <i>E. coli</i> and <i>Salmonella</i>, predominated, with no significant difference in causative agents across treatment groups. <b>Conclusions</b>: Biologic therapy greatly increases GI infection risk in IBD patients independent of PPI use. Clinicians should weigh infection risks when prescribing biologics, particularly in high-risk populations. Further studies are needed to assess risks by biologic subtype and the interplay with PPIs.https://www.mdpi.com/2227-9059/13/7/1676inflammatory bowel diseasebiologic therapyproton pump inhibitorsgastrointestinal infectionsclostridioides difficile |
| spellingShingle | Ryan Njeim Elie Moussa Chapman Wei Joelle Sleiman Reem Dimachkie Liliane Deeb Impact of Biologics and Proton Pump Inhibitors on Gastrointestinal Infection Risk in Inflammatory Bowel Disease Patients: A Retrospective Analysis of Pathogen-Specific Outcomes and Treatment Interactions Biomedicines inflammatory bowel disease biologic therapy proton pump inhibitors gastrointestinal infections clostridioides difficile |
| title | Impact of Biologics and Proton Pump Inhibitors on Gastrointestinal Infection Risk in Inflammatory Bowel Disease Patients: A Retrospective Analysis of Pathogen-Specific Outcomes and Treatment Interactions |
| title_full | Impact of Biologics and Proton Pump Inhibitors on Gastrointestinal Infection Risk in Inflammatory Bowel Disease Patients: A Retrospective Analysis of Pathogen-Specific Outcomes and Treatment Interactions |
| title_fullStr | Impact of Biologics and Proton Pump Inhibitors on Gastrointestinal Infection Risk in Inflammatory Bowel Disease Patients: A Retrospective Analysis of Pathogen-Specific Outcomes and Treatment Interactions |
| title_full_unstemmed | Impact of Biologics and Proton Pump Inhibitors on Gastrointestinal Infection Risk in Inflammatory Bowel Disease Patients: A Retrospective Analysis of Pathogen-Specific Outcomes and Treatment Interactions |
| title_short | Impact of Biologics and Proton Pump Inhibitors on Gastrointestinal Infection Risk in Inflammatory Bowel Disease Patients: A Retrospective Analysis of Pathogen-Specific Outcomes and Treatment Interactions |
| title_sort | impact of biologics and proton pump inhibitors on gastrointestinal infection risk in inflammatory bowel disease patients a retrospective analysis of pathogen specific outcomes and treatment interactions |
| topic | inflammatory bowel disease biologic therapy proton pump inhibitors gastrointestinal infections clostridioides difficile |
| url | https://www.mdpi.com/2227-9059/13/7/1676 |
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