Evidence-based consensus on opportunistic infections
in inﬂammatory bowel disease
Inﬂammatory Bowel Disease Group, Chinese Society of Gastroenterology, Chinese Medical Association
Inﬂammatory bowel disease (IBD), mainly including
Crohn’s disease (CD) and ulcerative colitis (UC), is a
chronic non-speciﬁc intestinal disease. The chronic,
protracted course of IBD severely affects the patient’s
quality of life. The treatment of IBD has gone through
three phases. Glucocorticoids were introduced in the
1950s, while immunosuppressive agents began to be
used in the 1960s, and therapeutics is now in the era
of biological agents. With the progression and contin-
uous standardization of its treatment, treatment efﬁ-
cacy for IBD has made great progress, resulted in
signiﬁcantly decreased complications and mortality in
the patients. However, monotherapy or combination
therapy with these drugs will change patient’simmune
status, which may bring corresponding issues, particu-
larly an increased risk of opportunistic infection.
Opportunistic infection refers to micro-organisms that
have limited or no pathogenic capacity in healthy
human bodies but cause diseases or induce infections
when the immune system is compromised by other
diseases such as acquired immunodeﬁciency syn-
drome (AIDS) or drug medications such as immuno-
suppressive agents. IBD patients are at a high risk for
opportunistic infections. First, the disease itself can
cause a reduced nutritional status in IBD patients. Sec-
ond, the application of glucocorticoids, immunosup-
pressive and biological agents can severely inhibit
patient’s immunity. Therefore, patients with IBD are
susceptible to opportunistic infections, which requires
much attention in clinical setting.
rates of various infectious diseases are relatively higher
in China compared with those in the Western coun-
tries. Positive prevention, early diagnosis and timely
control of opportunistic infections are on the premise
of improving the prognosis of IBD patients in China.
This consensus referenced the results of clinical
researches from both China and abroad, in combina-
tion with the characteristics of Chinese IBD patients,
to provide guidance for clinical practice.
The IBD group of the Chinese Society of Gastroenter-
ology, Chinese Medical Association organized the
experts from the aspects of IBD, infection, clinical epi-
demiology and evidence-based medicine to establish
this consensus using the Delphi method. Our IBD
experts were divided into seven research groups to per-
form literature retrieval, screening and assessments to
conﬁrm the patient-intervention-comparison-outcome
(PICO) issues that needed to be solved in the consen-
sus. Three rounds of voting (with a total of 58 experts
participating in it) were conducted through electronic
mails, and the ballots were counted by a third party.
Subsequently, in-person voting using a voting
machine was conducted with a total of 24 experts.
After two expert seminars, the draft was discussed,
amended, and passed in the plenary meeting of the
IBD group in China. After being reviewed and ﬁnal-
ized by experts in the aspects of infection and clinical
epidemiology, this consensus was ﬁnally established.
The three recommendation levels of this consensus
are as follows: level A, where the rating standard a was
passed by 3/4 or higher voting; level B, where the rat-
ing standard a + b was passed by 3/4 or higher voting;
and level C, where the abovementioned indicators
were not reached and were deleted. The rating stan-
dards were: a, total approval (indispensable, minimal
requirement); b, partial approval and
Correspondence to: Jia Ming QIAN, Department of Gastroenterology,
Peking Union Medical College Hospital, Peking Union Medical College,
Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Beijing 100730,
China. Email: email@example.com
The consensus has been published in Chinese on the Chinese
Journal of Digestion 2017; 37 (4): 217–26.
Conﬂicts of interest: None.
Accepted for publication 12 January 2018.
© 2018 Chinese Medical Association Shanghai Branch, Chinese
Society of Gastroenterology, Renji Hospital Afﬁliated to Shanghai
Jiaotong University School of Medicine and John Wiley & Sons
Journal of Digestive Diseases 2018; 19; 54–65 doi: 10.1111/1751-2980.12578