Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2024

Open Access 01-12-2024 | Opportunistic Infection | Research

Increasing ratio of opportunistic infections associated with sunshine exposure and economic level burdening Chinese inflammatory bowel disease hospitalized patients: the first nationwide survey from 2014 to 2019

Authors: Runing Zhou, Ruixian Wu, Li Wang, Hong Yang

Published in: BMC Public Health | Issue 1/2024

Login to get access

Abstract

Background

The rising prevalence of opportunistic infections (OIs) in inflammatory bowel disease (IBD) in conjunction with the use of biologics/immunosuppressive agents has garnered attention. However, there is a dearth of research on OIs in Mainland China. This study seeks to evaluate the national ratio trend of OIs in IBD and elucidate the influence of economic and climate factors on IBD patients with OIs and their outcomes.

Methods

The nationwide data was obtained from the Inpatient medical record home page via the Health Statistics and Information Reporting System (HSRS). Patients diagnosed with IBD were enlisted for participation, and their demographic and clinical information, encompassing infection type, surgical procedures, and expenses, were gathered. The National Bureau of Statistics provided data on monthly sunshine exposure hours and yearly Gross Domestic Product (GDP).

Results

Findings indicate that between 2014 and 2019, a total of 381,752 patients with IBD were admitted to hospitals, with 364,249 patients lacking OIs and 17,503 patients presenting with OIs. The annual proportion of OIs exhibited an upward trend, rising from 3.54% in 2014 to 4.81% in 2019. There was a significant correlation observed between individuals who identified as male, those who visited hospitals in southern regions, or those originating from areas with lower GDP or shorter sunshine exposure hours, and a higher incidence of OIs. Among patients diagnosed with either Crohn’s disease (CD) or ulcerative colitis (UC), Clostridium difficile was found to be the most prevalent infection, followed by Epstein-Barr virus and cytomegalovirus. Furthermore, the occurrence of OIs was found to be associated with an increased rate of surgical interventions in UC patients.

Conclusions

The rising prevalence of OIs among hospitalized patients with IBD necessitates heightened attention towards mitigating associated risk factors, particularly among IBD patients residing in less developed regions or experiencing limited exposure to sunlight. This approach aims to minimize hospital stays and associated costs.
Appendix
Available only for authorised users
Literature
1.
Prideaux L, Kamm MA, De Cruz PP, Chan FK, Ng SC. Inflammatory bowel disease in Asia: a systematic review. J Gastroenterol Hepatol. 2012;27(8):1266–80.PubMedCrossRef
2.
Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2018;390(10114):2769–78.CrossRef
3.
Kirchgesner J, Lemaitre M, Carrat F, Zureik M, Carbonnel F, Dray-Spira R. Risk of Serious and opportunistic infections Associated with Treatment of Inflammatory Bowel diseases. Gastroenterology. 2018;155(2):337–46. e10.PubMedCrossRef
4.
Beaugerie L, Rahier JF, Kirchgesner J. Predicting, preventing, and managing treatment-related complications in patients with inflammatory Bowel diseases. Clin Gastroenterol Hepatol. 2020;18(6):1324–35. e2.PubMedCrossRef
5.
Kucharzik T, Ellul P, Greuter T, Rahier JF, Verstockt B, Abreu C, et al. ECCO Guidelines on the Prevention, diagnosis, and management of infections in inflammatory bowel disease. J Crohns Colitis. 2021;15(6):879–913.PubMedCrossRef
6.
Mylonaki M, Langmead L, Pantes A, Johnson F, Rampton DS. Enteric infection in relapse of inflammatory bowel disease: importance of microbiological examination of stool. Eur J Gastroenterol Hepatol. 2004;16(8):775–8.PubMedCrossRef
7.
McCurdy JD, Enders FT, Khanna S, Bruining DH, Jones A, Killian JM, et al. Increased rates of Clostridium difficile infection and poor outcomes in patients with IBD with cytomegalovirus. Inflamm Bowel Dis. 2016;22(11):2688–93.PubMedCrossRef
8.
Barber GE, Hendler S, Okafor P, Limsui D, Limketkai BN. Rising incidence of intestinal infections in inflammatory bowel disease: a nationwide analysis. Inflamm Bowel Dis. 2018;24(8):1849–56.PubMedCrossRef
9.
Axelrad JE, Olen O, Askling J, Lebwohl B, Khalili H, Sachs MC, et al. Gastrointestinal infection increases odds of Inflammatory Bowel Disease in a Nationwide Case-Control Study. Clin Gastroenterol Hepatol. 2019;17(7):1311–22. e7.PubMedCrossRef
10.
Toruner M, Loftus EV Jr., Harmsen WS, Zinsmeister AR, Orenstein R, Sandborn WJ, et al. Risk factors for opportunistic infections in patients with inflammatory bowel disease. Gastroenterology. 2008;134(4):929–36.PubMedCrossRef
11.
Rajbhandari R, Blakemore S, Gupta N, Adler AJ, Noble CA, Mannan S, et al. Crohn’s disease in low and lower-middle income countries: a scoping review. World J Gastroenterol. 2020;26(43):6891–908.PubMedPubMedCentralCrossRef
12.
Parente JM, Coy CS, Campelo V, Parente MP, Costa LA, da Silva RM, et al. Inflammatory bowel disease in an underdeveloped region of Northeastern Brazil. World J Gastroenterol. 2015;21(4):1197–206.PubMedPubMedCentralCrossRef
13.
Nakano T, Chiang KC, Chen CC, Chen PJ, Lai CY, Hsu LW et al. Sunlight exposure and phototherapy: perspectives for healthy aging in an era of COVID-19. Int J Environ Res Public Health. 2021;18(20).
14.
Weber DJ, Anderson DJ, Sexton DJ, Rutala WA. Role of the environment in the transmission of Clostridium difficile in health care facilities. Am J Infect Control. 2013;41(5 Suppl):105–10.CrossRef
15.
Commission NHaFP. Statistical yearbook of Health and Family Planning in China. Volume 13. Beijing: Peking Union Medical College Press; 2016. p. 128.
16.
Inflammatory Bowel Disease Group CSoDD, Chinese Medical Association. Chinese evidence-based consensus on opportunistic infections in inflammatory bowel disease. Chin J Gastroenterol. 2017;37(4):217–26.
17.
Gu YB, Zhang MC, Sun J, Lv KZ, Zhong J. Risk factors and clinical outcome of Clostridium difficile infection in patients with IBD: a single-center retrospective study of 260 cases in China. J Dig Dis. 2017;18(4):207–11.PubMedCrossRef
18.
Sheriff MZ, Mansoor E, Luther J, Ananthakrishnan AN, Abou Saleh M, Ho E, et al. Opportunistic infections are more prevalent in Crohn’s Disease and Ulcerative Colitis: a large Population-based study. Inflamm Bowel Dis. 2020;26(2):291–300.PubMedCrossRef
19.
Li Y, Xu H, Xu T, Xiao M, Tang H, Wu D, et al. Case-Control Study of Inflammatory Bowel Disease patients with and without Clostridium difficile infection and poor outcomes in patients coinfected with C. Difficile and Cytomegalovirus. Dig Dis Sci. 2018;63(11):3074–83.PubMedPubMedCentralCrossRef
20.
Nguyen GC, Kaplan GG, Harris ML, Brant SR. A national survey of the prevalence and impact of Clostridium difficile infection among hospitalized inflammatory bowel disease patients. Am J Gastroenterol. 2008;103(6):1443–50.PubMedCrossRef
21.
Yi F, Zhao J, Luckheeram RV, Lei Y, Wang C, Huang S, et al. The prevalence and risk factors of cytomegalovirus infection in inflammatory bowel disease in Wuhan, Central China. Virol J. 2013;10:43.PubMedPubMedCentralCrossRef
22.
Yang H, Qian J. Current status of Cytomegalovirus Colitis among patients with inflammatory bowel disease in China: a questionnaire-based Multicenter Study. Inflamm Bowel Dis. 2022;28(Supplement2):45–S51.CrossRef
23.
Yang H, Ran Z, Jin M, Qian JM. Current status of opportunistic infection in inflammatory bowel disease patients in Asia: a questionnaire-based Multicenter Study. Gut Liver. 2022.
24.
Li X, Chen N, You P, Peng T, Chen G, Wang J, et al. The Status of Epstein-Barr Virus infection in intestinal mucosa of Chinese patients with inflammatory bowel disease. Digestion. 2019;99(2):126–32.PubMedCrossRef
25.
Xu S, Chen H, Zu X, Hao X, Feng R, Zhang S, et al. Epstein-Barr virus infection in ulcerative colitis: a clinicopathologic study from a Chinese area. Th Adv Gastroenterol. 2020;13:1756284820930124.
26.
Zhou JQ, Zeng L, Zhang Q, Wu XY, Zhang ML, Jing XT, et al. Clinical features of Epstein-Barr virus in the intestinal mucosa and blood of patients with inflammatory bowel disease. Saudi J Gastroenterol. 2020;26(6):312–20.PubMedPubMedCentralCrossRef
27.
Wang W, Chen X, Pan J, Zhang X, Zhang L. Epstein-Barr Virus and human cytomegalovirus infection in intestinal mucosa of Chinese patients with inflammatory bowel disease. Front Microbiol. 2022;13:915453.PubMedPubMedCentralCrossRef
28.
Hong LA-l, Ji LI, Dong WU, Yi-xiao ZHAO. QIAN Jia-Ming. Clinical characteristics of Ulcerative Colitis complicated with opportunistic infections in Elderly patients. Acta Academiae Medicinae Sinica. 2016;38(3):288–93.
29.
Mao EJ, Hazlewood GS, Kaplan GG, Peyrin-Biroulet L, Ananthakrishnan AN. Systematic review with meta-analysis: comparative efficacy of immunosuppressants and biologics for reducing hospitalisation and surgery in Crohn’s disease and ulcerative colitis. Aliment Pharmacol Ther. 2017;45(1):3–13.PubMedCrossRef
30.
Mourad FH, Hashash JG, Kariyawasam VC, Leong RW. Ulcerative colitis and cytomegalovirus infection: from a to Z. J Crohns Colitis. 2020;14(8):1162–71.PubMedCrossRef
31.
Gruszecka J, Filip R. Retrospective analysis of Clostridioides difficile and other intestinal infections in patients with Crohn’s disease and ulcerative colitis in the tertiary hospital in Poland. POLIBD survey results. Gut Pathog. 2021;13(1):73.PubMedPubMedCentralCrossRef
32.
Nunez Ortiz A, Rojas Feria M, de la Cruz Ramirez MD, Gomez Izquierdo L, Trigo Salado C, Herrera Justiniano JM, et al. Impact of Epstein-Barr virus infection on inflammatory bowel disease (IBD) clinical outcomes. Rev Esp Enferm Dig. 2022;114(5):259–65.PubMed
33.
Mosley A. Does HIV or poverty cause AIDS? Biomedical and epidemiological perspectives. Theor Med Bioeth. 2004;25(5–6):399–421.PubMedCrossRef
34.
Dheda K, Barry CE 3rd, Maartens G. Tuberculosis Lancet. 2016;387(10024):1211–26.
35.
Watermeyer G, Awuku Y, Fredericks E, Epstein D, Setshedi M, Devani S, et al. Challenges in the management of inflammatory bowel disease in sub-saharan Africa. Lancet Gastroenterol Hepatol. 2022;7(10):962–72.PubMedCrossRef
36.
Rotheram S, Cooper J, Barr B, Whitehead M. How are inequalities generated in the management and consequences of gastrointestinal infections in the UK? An ethnographic study. Soc Sci Med. 2021;282:114131.PubMedPubMedCentralCrossRef
37.
Banerjee R, Pal P, Mak JWY, Ng SC. Challenges in the diagnosis and management of inflammatory bowel disease in resource-limited settings in Asia. Lancet Gastroenterol Hepatol. 2020;5(12):1076–88.PubMedCrossRef
38.
Hobday RA, Dancer SJ. Roles of sunlight and natural ventilation for controlling infection: historical and current perspectives. J Hosp Infect. 2013;84(4):271–82.PubMedPubMedCentralCrossRef
39.
Ananthakrishnan AN, Cagan A, Gainer VS, Cheng SC, Cai T, Szolovits P, et al. Higher plasma vitamin D is associated with reduced risk of Clostridium difficile infection in patients with inflammatory bowel diseases. Aliment Pharmacol Ther. 2014;39(10):1136–42.PubMedPubMedCentralCrossRef
40.
Jantchou P, Clavel-Chapelon F, Racine A, Kvaskoff M, Carbonnel F, Boutron-Ruault MC. High residential sun exposure is associated with a low risk of incident Crohn’s disease in the prospective E3N cohort. Inflamm Bowel Dis. 2014;20(1):75–81.PubMedCrossRef
41.
Paynter S, Weinstein P, Ware RS, Lucero MG, Tallo V, Nohynek H, et al. Sunshine, rainfall, humidity and child pneumonia in the tropics: time-series analyses. Epidemiol Infect. 2013;141(6):1328–36.PubMedCrossRef
42.
Barbut F. How to eradicate Clostridium difficile from the environment. J Hosp Infect. 2015;89(4):287–95.PubMedCrossRef
43.
Marra AR, Schweizer ML, Edmond MB. No-Touch disinfection methods to decrease multidrug-resistant organism infections: a systematic review and Meta-analysis. Infect Control Hosp Epidemiol. 2018;39(1):20–31.PubMedCrossRef
44.
Arihiro S, Nakashima A, Matsuoka M, Suto S, Uchiyama K, Kato T, et al. Randomized Trial of Vitamin D Supplementation to prevent Seasonal Influenza and Upper respiratory infection in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2019;25(6):1088–95.PubMedPubMedCentralCrossRef
45.
McCullough PJ, Lehrer DS, Vitamin D. Cod liver oil, sunshine, and phototherapy: safe, effective and forgotten tools for treating and curing tuberculosis infections - a comprehensive review. J Steroid Biochem Mol Biol. 2018;177:21–9.PubMedCrossRef
46.
Feakins R, Torres J, Borralho-Nunes P, Burisch J, Cúrdia Gonçalves T, De Ridder L, et al. ECCO Topical Review on Clinicopathological Spectrum and Differential diagnosis of inflammatory bowel disease. J Crohn’s Colitis. 2022;16(3):343–68.CrossRef
Metadata
Title
Increasing ratio of opportunistic infections associated with sunshine exposure and economic level burdening Chinese inflammatory bowel disease hospitalized patients: the first nationwide survey from 2014 to 2019
Authors
Runing Zhou
Ruixian Wu
Li Wang
Hong Yang
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-024-17635-6

Other articles of this Issue 1/2024

BMC Public Health 1/2024 Go to the issue

Research

Enhancing indicator condition–guided HIV testing in Taiwan: a nationwide case–control study from 2009 to 2015

Research

Exploring the medical decision-making patterns and influencing factors among the general Chinese public: a binary logistic regression analysis

Research

Multiple mediation of the association between childhood emotional abuse and adult obesity by anxiety and bulimia – a sample from bariatric surgery candidates and healthy controls

Research

The mediating role of children’s intergenerational support in association between grandparenting and cognitive function among middle-aged and older Chinese: findings from the CHARLS cohort study

Research

Changes in disease burden and global inequalities in bladder, kidney and prostate cancers from 1990 to 2019: a comparative analysis based on the global burden of disease study 2019

Research

Experience and impact of stigma in people with chronic hepatitis B: a qualitative study in Asia, Europe, and the United States