Anti-tumor necrosis factor (anti-TNF) is highly effective in inflammatory bowel disease (IBD); however, it is associated with an increased risk of infections, particularly in older adults. We reviewed 349 patients with IBD, who were observed over a 12-month period, 74 of whom had received anti-TNF therapy (71 patients were aged <60 years and 3 were aged ≥60 years). All the 3 older patients developed serious infectious complications after receiving anti-TNFs, although all of them were also on concomitant immunosuppressive therapy. One patient developed disseminated tuberculosis, another patient developed cholera diarrhea followed by nosocomial pneumonia, while the third patient developed multiple opportunistic infections (Pneumocystis pneumonia, cryptococcal septicemia and meningitis, Klebsiella septicemia). All 3 patients died within 1 year from the onset of the infection(s). We recommend that anti-TNF, especially when combined with other immunosuppressive therapy, should be used with extreme caution in older adult patients with IBD.
Adult ; Cholera ; Diarrhea ; Humans ; Inflammatory Bowel Diseases* ; Klebsiella ; Meningitis ; Necrosis* ; Opportunistic Infections ; Pneumonia ; Sepsis ; Tuberculosis

Background: The Emergency Department (ED) is the major entry point for patients admitted into the hospital. The continued use of urinary catheters from the ED is identified as a risk for patients to develop catheter associated urinary tract infection (CAUTI). Objective: This study aimed firstly to identify the prevalence of ED-related CAUTI in our centre, University Malaya Medical Centre and the appropriateness of catheter use among all the cases. Secondly, to assess the impact of a urinary catheter care bundle E-learning training module on the rates of CAUTI and appropriate use of urinary catheter. Method: A pre-post intervention study was conducted between June 2017 and April 2019. A retrospective analysis was conducted to assess the changes in infection rate before and after the training module. The urinary care bundle E learning tutorial module was developed, and all ED staff were trained using this module from September 2018 to November 2018. Outcome measures were the prevalence rate of ED-related CAUTI, the rate of appropriateness indication in urinary catheter insertion and the association between patient’s characteristic and the rate of appropriateness in urinary catheterization. Result: The CAUTI rates were significantly dropped from 17.04 per 1000 device days in pre-intervention period to 7.4 in post-intervention period (p=0.03). Conclusion An online training module on urinary catheter bundle effectively reduced CAUTIs but not improve the appropriate use of urinary catheter. Therefore, further study is needed to improve the rate of appropriateness in urinary catheter insertion.