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Intestinal cytomegalovirus infection in patients hospitalized for exacerbation of inflammatory bowel disease: a 10-year tertiary referral center experience

Gauss, Annika; Rosenstiel, Simon; Schnitzler, Paul; Hinz, Ulf; Rehlen, Tobias; Kadmon, Martina; Ehehalt, Robert; Stremmel, Wolfgang; Zawierucha, Anna

European Journal of Gastroenterology & Hepatology: June 2015 - Volume 27 - Issue 6 - p 712–720
doi: 10.1097/MEG.0000000000000361
Original Articles: Inflammatory Bowel Diseases

Objectives This 10-year retrospective cohort study aims to determine the prevalence and risk factors of cytomegalovirus (CMV) infection in inpatients with exacerbated inflammatory bowel disease (IBD).

Methods All patients admitted to the Department of Gastroenterology of the University Hospital Heidelberg for IBD exacerbation between January 2004 and June 2013 were enrolled. To identify the risk factors of CMV infection, infected individuals were compared with those with excluded infection.

Results Among 297 patients with exacerbated IBD, 21 had confirmed CMV infection and 79 had excluded CMV infection, whereas the remaining patients had not been sufficiently tested for CMV. Taking into account only sufficiently tested individuals, the prevalence of CMV infection was 22.7% in ulcerative colitis and 16.0% in Crohn’s disease. The occurrence of CMV infection was associated with the following variables at admission: age of 30 years or more [odds ratio (OR) 14.29; P=0.004], disease duration less than 60 months (OR 7.69; P=0.011), a blood leukocyte count less than 11/nl (OR 4.49; P=0.041), and immunosuppressive therapy (OR 6.73; P=0.0129). CMV-positive patients remained in the hospital longer than noninfected patients (P=0.0009). In the CMV-positive cohort, a 66-year-old woman died of CMV pneumonia and sepsis, whereas there was no death in the CMV-negative cohort.

Conclusion Immunuosuppressive therapy and age older than 30 years were identified as the main risk factors for the development of CMV infection in exacerbated IBD. Because of the risk of death, diagnostics of CMV infection should especially be initiated in older patients on immunosuppressive therapy.

Departments of aGastroenterology

bInfectious Diseases, Virology

cSurgery, University Hospital Heidelberg

dOutpatient Clinic of Gastroenterology, Heidelberg, Germany

Correspondence to Annika Gauss, MD, Department of Gastroenterology, University Hospital Heidelberg, INF 410, 69120 Heidelberg, Germany Tel: +49 (0)6221 56 38865; fax: +49 (0)6221 56 5255; e-mail: annika.gauss@med.uni-heidelberg.de

Received January 19, 2015

Accepted March 5, 2015

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.