Clostridium difficile Infection in Patients with Inflammatory Bowel Disease

Fu, Nancy; Wong, Titus

doi:10.1007/s11908-016-0525-x

Cited by 14 publications

(22 citation statements)

References 90 publications

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“…Increasing incidence and severity of CDI have been described among IBD patients, with the majority of diagnosed CDI being community-associated [30]. Patients with IBD can have dysbiosis of the intestinal microbiota and altered bile salt composition that can facilitate CDI development [31]. Cardiac disease and chronic renal failure were also significantly associated with CA-CDI and can lead to severe illness that might predispose patients to CDI.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Community-Associated Clostridium difficile Infection in Adults: A Case-Control Study

Guh

Adkins

et al. 2017

Open Forum Infectious Diseases

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BackgroundAn increasing proportion of Clostridium difficile infections (CDI) in the United States are community-associated (CA). We conducted a case-control study to identify CA-CDI risk factors.MethodsWe enrolled participants from 10 US sites during October 2014–March 2015. Case patients were defined as persons age ≥18 years with a positive C. difficile specimen collected as an outpatient or within 3 days of hospitalization who had no admission to a health care facility in the prior 12 weeks and no prior CDI diagnosis. Each case patient was matched to one control (persons without CDI). Participants were interviewed about relevant exposures; multivariate conditional logistic regression was performed.ResultsOf 226 pairs, 70.4% were female and 52.2% were ≥60 years old. More case patients than controls had prior outpatient health care (82.1% vs 57.9%; P < .0001) and antibiotic (62.2% vs 10.3%; P < .0001) exposures. In multivariate analysis, antibiotic exposure—that is, cephalosporin (adjusted matched odds ratio [AmOR], 19.02; 95% CI, 1.13–321.39), clindamycin (AmOR, 35.31; 95% CI, 4.01–311.14), fluoroquinolone (AmOR, 30.71; 95% CI, 2.77–340.05) and beta-lactam and/or beta-lactamase inhibitor combination (AmOR, 9.87; 95% CI, 2.76–340.05),—emergency department visit (AmOR, 17.37; 95% CI, 1.99–151.22), white race (AmOR 7.67; 95% CI, 2.34–25.20), cardiac disease (AmOR, 4.87; 95% CI, 1.20–19.80), chronic kidney disease (AmOR, 12.12; 95% CI, 1.24–118.89), and inflammatory bowel disease (AmOR, 5.13; 95% CI, 1.27–20.79) were associated with CA-CDI.ConclusionsAntibiotics remain an important risk factor for CA-CDI, underscoring the importance of appropriate outpatient prescribing. Emergency departments might be an environmental source of CDI; further investigation of their contribution to CDI transmission is needed.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Community-Associated Clostridium difficile Infection in Adults: A Case-Control Study

Guh

Adkins

et al. 2017

Open Forum Infectious Diseases

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“…In the setting of poor baseline nutritional status and immunosuppressive therapy, patients with IBD are at high risk particularly for nosocomial complications. For example, C lostridium difficile infection is now the leading cause of nosocomial infection, with a concurrent upsurge among patients with IBD 7. Additionally, hospitalised patients with IBD are at an increased risk of multidrug-resistant organisms compared with inpatients with general medical and non-GI–IBD, such as those with methicillin-resistant Staphylococcus aureus 10.…”

Section: Discussionmentioning

confidence: 99%

“…Regardless, typical management includes prolonged hospitalisation, which places patients at risk of nosocomial infections, multidrug-resistant organisms and venous thromboembolism, among other preventable complications 7–10. Additionally, prolonged duration of preoperative medical treatment correlates with poorer outcomes after surgery for ASUC 11…”

Section: Introductionmentioning

confidence: 99%

Change in paradigm: impact of an IBD medical home on the outpatient management of acute severe ulcerative colitis

et al. 2019

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A 72-year-old man presents with acute severe ulcerative colitis (ASUC), initially partially responsive to intravenous steroids and infliximab over a 3-day hospital stay. Following discharge and over the course of 15 days, his care was coordinated by the inflammatory bowel disease medical home team, who conducted clinical laboratory assessments and two outpatient flexible sigmoidoscopies to evaluate endoluminal disease activity and treatment response prior to proceeding with a laparoscopic total abdominal colectomy and creation of end ileostomy following medical failure. He was admitted to the hospital for a total of only 7 days, which included attempted medical management of ASUC, surgery and postoperative recovery.

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“…As compared to nosocomial CDI, IBD-related infection appears to occur in younger patients who have not received antibiotics recently. Antibiotic exposure has found to occur only in 40-60% of IBD patients with subsequent CDI [23,24]. However, in IBD patients antibiotics have been associated with rCDI [6].…”

Section: Discussionmentioning

confidence: 99%