Frequency and Risk Factors of Clostridium difficile Infection in Hospitalized Patients With Pouchitis

Kistangari, Gaurav; López, Rocío; Shen, Bo

doi:10.1097/mib.0000000000001057

Cited by 19 publications

(8 citation statements)

References 39 publications

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“…In comparison to previous smaller studies, we did not observe male gender, preoperative left-sided colitis, lower BMI, or medical comorbidities to be risk factors for pouch CDI[18, 19]. Common risk factors for CDI in the general population include recent antibiotic use, gastric acid suppression therapy use, and hospital admission; however, none of these were observed to be significantly associated with pouch CDI in our population[10-12].…”

Section: Discussioncontrasting

confidence: 92%

Clostridioides Difficile Infection Is a Rare Cause of Infectious Pouchitis

et al. 2020

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Introduction: The true incidence of Clostridioides difficile infection (CDI) in patients with an ileal pouch is unknown, and there is little published on its associated risk factors. Objective: We aimed to evaluate the rate and risk factors of CDI in pouch patients. Methods: This was a retrospective review conducted at a single tertiary care inflammatory bowel disease (IBD) center. All ulcerative colitis or IBD-unspecified (IBD-U) patients who underwent total proctocolectomy with ileal pouch anal anastomosis for medically refractory disease or dysplasia between 2008 and 2017 were identified. Symptomatic patients tested for CDI were included. Demographic, disease, and surgical characteristics were collected. Nonparametric methods were used to compare continuous outcomes, and χ² and Fisher’s exact tests were used to compare patients with and without CDI as appropriate. Results: A total of 154 pouch patients had postoperative C. difficilestool testing for symptoms of fever, urgency, increased stool frequency, hematochezia, incontinence, and abdominal and/or pelvic pain. CDI was diagnosed in 11 (7.1%) patients a median of 139 days (IQR 34–1,170) after the final surgical stage. Ten patients (90.9%) received oral vancomycin for 10 days and 1 patient (9.1%) received oral metronidazole for 2 weeks. Ten patients (90.9%) reported improvement in symptoms at completion of therapy. Nine patients (81.8%) were retested for CDI for recurrent symptoms and found to be negative. No patient had CDI recurrence. There was no significant difference in demographic and surgical characteristics, previous antibiotic or proton pump inhibitor use, or previous hospital admission among the patients with and without CDI. Conclusions: CDI is a rare cause of infectious pouchitis and treatment with oral vancomycin improves symptoms.

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Section: Discussioncontrasting

confidence: 92%

Clostridioides Difficile Infection Is a Rare Cause of Infectious Pouchitis

et al. 2020

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“…In addition to patient and clinical factors that have previously been associated with CDI, the authors evaluated the association between body mass index (BMI) and CDI. Prior data from the same group had suggested that obesity and the obesity-related diseases, non-alcoholic fatty liver disease (NAFLD) and obstructive sleep apnea (OSA) were associated with increased risk of CDI among IBD patients with IPAA [6]. In contrast, the current study by Gosai et al found that obesity was independently associated with a lower risk of CDI according to multivariable analysis.…”

contrasting

confidence: 78%

“…Until recently, the description of CDI in IPAA patients has been limited to case reports and case series, which were reviewed in detail by Seril and Shen in 2014 [5]. A recent population-based study using administrative data identified 3470 IBD patients admitted to hospital with pouchitis, estimating that CDI occurs in 2.6% of these admissions [6]. Furthermore, there is a literature showing that CDI of the pouch may be manifest with more systemic symptoms (e.g., fever, night sweats, and weight loss) and is associated with higher rates of recurrent CDI and refractory infection [5].…”

mentioning

confidence: 99%

Mixed Bag: How C. Difficile Can Cause Pouchitis

Stewart

2019

Dig Dis Sci

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“…Those with sepsis more often had inflammation in the upper pouch only, and although some had a collection that could be drained radiologically, outcomes were poor with most remaining on long-term antibiotics and nearly a third having a defunctioning stoma or pouch excision 293. In patients with chronic pouchitis 20%–30% have secondary causes for their symptoms, which include CMV infection, Candida , Clostridium difficile, 295 ischaemia, autoimmune disorder, or damage from radiotherapy, chemotherapy or non-steroidal anti-inflammatory drugs 180 296. A proportion may have Crohn’s disease, with reported frequency ranging from 3.6%–13% 297…”

Section: Ulcerative Colitismentioning

confidence: 99%

British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults

Lamb

Kennedy

Raine

et al. 2019

Gut

1,624

1,816

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Ulcerative colitis and Crohn’s disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn’s and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn’s disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn’s disease, including patients, their families and friends.

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Frequency and Risk Factors of Clostridium difficile Infection in Hospitalized Patients With Pouchitis

Abstract: It seems that CDI was limited to pouchitis with underlying IBD and rare in those with underlying FAP. Patients with nonalcoholic fatty liver disease, obesity, and obstructive sleep apnea are at an increased risk of C. difficile pouchitis among patients with IBD.

Cited by 19 publications

References 39 publications

<b><i>Clostridioides Difficile</i></b> Infection Is a Rare Cause of Infectious Pouchitis

<b><i>Clostridioides Difficile</i></b> Infection Is a Rare Cause of Infectious Pouchitis

Mixed Bag: How C. Difficile Can Cause Pouchitis

British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults

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