Empiric Antibiotic Use With Rescue Infliximab Does Not Improve Outcomes in Acute Severe Ulcerative Colitis: A Retrospective Cohort Study

Background and Aims: Antibiotics are sometimes prescribed as concurrent therapy in the management of acute severe ulcerative colitis (ASUC) with a rationale of treating any presumed concurrent infections. It is unclear if there are data indicating any benefit of this clinical practice. We sought to evaluate the concurrent use of antibiotics with infliximab in patients hospitalized for the treatment of ASUC. Methods: We performed a retrospective cohort study on hospitalized patients with ASUC, comparing the outcomes of patients who received both rescue infliximab and antibiotics to patients who received rescue infliximab without antibiotics. The comparative cohorts were derived from the TriNetX US Collaborative Network. Propensity score matching was used to balance cohorts on baseline demographic and clinical characteristics. Kaplan Meier analyses and hazard ratios with 95% confidence intervals were calculated. Results: Concurrent administration of antibiotics and antimicrobials with rescue infliximab in ASUC does not result in any benefit in IBD related surgery (HR: 1.18; 95% CI: 0.82–1.70), colectomy (HR: 1.08; 95% CI: 0.54–2.13), sepsis (HR: 1.36; 95% CI: 0.84–2.20) and mortality (HR: 0.81; 95% CI: 0.32–2.05). Furthermore, the antibiotic cohort was more likely to utilize emergency department services (HR: 1.29; 95% CI: 1.02–1.64) and critical care services (HR: 2.36; 95% CI: 1.31–4.24) in the studied outcome time period. Conclusion: Empiric administration of antibiotics or antimicrobials with infliximab rescue therapy in ASUC does not improve outcomes and may be associated with higher health care utilization.