Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease


Journal of Crohn's and Colitis (2014) 8, 443-468; PMID 24613021


The treatment of inflammatory bowel disease (IBD) has been revolutionised over the past decade by the increasing use of immunomodulators. With such immunomodulation, the potential for opportunistic infection is a key safety concern for patients with IBD. Opportunistic infections pose particular problems for the clinician: they are often difficult to recognise and are associated with appreciable morbidity or mortality, because they are potentially serious and hard to treat effectively. This led the European Crohn's and Colitis Organisation (ECCO) to update the previous Consensus meeting on opportunistic infections in IBD. To organise the work, infections were classified into six major topics. Guideline statements of 2009 were analysed systematically by the chairs and the working parties. In parallel, the working parties performed a systematic literature search of their topic with the appropriate key words using Medline/Pubmed and the Cochrane database, as well as their own files. The evidence level (EL) was graded according to the 2011 Oxford Centre for Evidence-Based Medicine ( Provisional update guideline statements were then posted on a weblog. Discussions and exchange of the literature evidence among the working party members was then performed on the weblog. The working parties then met in Lilleonthe15th– 16th of November 2012 to agree on the statements. Consensus was defined as agreement by N80% of participants, termed a Consensus Statement and numbered for convenience in the document. This paper is the product of work by gastroenterologists, infectious disease experts and pediatricians. It provides guidance on the prevention, detection and management of opportunistic infections in patients of all age categories with IBD. After asection on definitions and risk factors for developing opportunistic infection, there are five sections on different infectious agents, followed by a section on information and guidance for patients with IBD travelling frequently or to less economically developed countries. In the final section, a systematic work up and vaccination programme is proposed for consideration in patients exposed to immunomodulator therapies.

Keywords: opportunistic infections; inflammatory bowel disease; ECCO guidelines

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