Prevalence of Clostridium difficile infection among hospitalized inflammatory bowel disease patients in Greece

Viazis, Nikos; Pontas, C; Karmiris, Konstantinos; Dimas, Ioannis; Fragaki, Maria; Paspatis, Grigorios; Drygiannakis, Ioannis; Koutroubakis, Ioannis Ε.; Moschovis, Dimitris; Tzouvala, Maria; Theocharis, Georgios; Tsolias, Chrysostomos; Thomopoulos, Konstantinos; Zampeli, Evanthia; Axiaris, Georgios; Michopoulos, Spyros; Belesiotou, Eleni; Banasa, Maria; Maraki, Sofia; Kouskoumpekou, Fotini; Αποστολόπουλος, Γ.; Stamouli, Vasiliki; Prifti, H.; Mantzaris, Gerasimos

doi:10.1097/meg.0000000000001414

Cited by 9 publications

(9 citation statements)

References 23 publications

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“…A study reported that the prevalence of CDI in IBD patients receiving azathioprine was significantly higher, and that patients on combined-therapy with a biologic agent and an immunomodulator showed no CDI. 16 Similarly, another study demonstrated that the use of immunomodulators such as azathioprine and 6-mercaptopurine, or mesalamine, was associated with the development of CDI. The maintenance of immunosuppression was independently associated with the emergence of CDI in IBD patients.…”

Section: Pathogenesismentioning

confidence: 97%

The interplay of Clostridioides difficile infection and inflammatory bowel disease

Sehgal

Yadav

Khanna

2021

Therap Adv Gastroenterol

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Inflammatory bowel disease (IBD) is a chronic disease of the intestinal tract that commonly presents with diarrhea. Clostridioides difficile infection (CDI) is one of the most common complications associated with IBD that lead to flare-ups of underlying IBD. The pathophysiology of CDI includes perturbations of the gut microbiota, which makes IBD a risk factor due to the gut microbial alterations that occur in IBD, predisposing patients CDI even in the absence of antibiotics. Superimposed CDI not only worsens IBD symptoms but also leads to adverse outcomes, including treatment failure and an increased risk of hospitalization, surgery, and mortality. Due to the overlapping symptoms and concerns with false-positive molecular tests for CDI, diagnosing CDI in patients with IBD remains a clinical challenge. It is crucial to have a high index of suspicion for CDI in patients who seem to be experiencing an exacerbation of IBD symptoms. Vancomycin and fidaxomicin are the first-line treatments for the management of CDI in IBD. Microbiota restoration therapies effectively prevent recurrent CDI in IBD patients. Immunosuppression for IBD in IBD patients with CDI should be managed individually, based on a thorough clinical assessment and after weighing the pros and cons of escalation of therapy. This review summarizes the epidemiology, pathophysiology, the diagnosis of CDI in IBD, and outlines the principles of management of both CDI and IBD in IBD patients with CDI.

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Section: Pathogenesismentioning

confidence: 97%

The interplay of Clostridioides difficile infection and inflammatory bowel disease

Sehgal

Yadav

Khanna

2021

Therap Adv Gastroenterol

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“…A retrospective analysis in Greece showed that compared with patients without IBD, hospitalized IBD had a higher CDI rate. 19 We found that CD patients in group A2 were more likely to have CDI than group A3, the occurrence rates were 17.05% and 6.67%, respectively. CDI could increase the health care burden and 90-day CDI-specific readmission rate of IBD, 20 and it could increase the risk of surgery by depleting the beneficial fecal microbiome and methionine biosynthesis.…”

Section: Discussionmentioning

confidence: 66%

Clinical Features of Crohn’s Disease Stratified by Age at Diagnosis According to Montreal Classification

Xiang¹,

Li²,

Liu³

et al. 2023

JIR

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Aim The differences of clinical characteristics stratified by age at diagnosis especially according to Montreal classification were rarely studied in China. This study aimed to evaluate and compare the clinical features in various groups of CD patients stratified by age at diagnosis. Methods A cross-sectional study of CD patients was conducted through a stratified sampling according to Montreal classification. Patients were divided into three groups by age at diagnosis: group A1 (<17 years old), group A2 (17 to 40 years old), and group A3 (>40 years old). The clinical characteristics, laboratory tests, radiographic, and endoscopic features were analyzed by statistics. Results We enrolled 259 CD patients for the study. There was male predominance under 40 years old. Compared to group A1, more female patients were presented in group A3. There were more patients had perianal fistulas in group A1 compared to group A2 and group A3. Compared with group A1, patients in group A2 were associated with lower total protein (TP) levels. The mean TP and platelet count (PC) levels in group A3 were lower than group A1. Patients in group A1 had a lower rate of stricturing (B2) disease behavior than group A2 and group A3, and patients in group A3 who had a B2 disease behavior were higher than group A2. Those differences could guide early treatment or inventions for CD patients who might progress to a more complex disease behavior. Conclusion CD patients stratified by age at diagnosis according to Montreal classification had different clinical symptoms, laboratory test results as well as disease locations and behaviors.

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“…When being asked to comment on CDI management in IBD, 46% of 169 gastroenterologists (25% of respondents were IBD specialists) opted for a combination of immunosuppression and antibiotics, while the remaining 54% preferred antibiotics alone to treat the flare. 32,44 In addition, Beniwal-Patel et al suggested that new immunosuppressants should not be started and scheduled infusions should be suspended until the symptoms of C. difficile are resolved in the case of new CDI. 10 While Krishna et al pointed out that IBD patients with CDI should be treated with appropriate antibiotics immediately.…”

Section: How To Manage Medications For Ibdmentioning

confidence: 99%

Inflammatory bowel disease and Clostridium difficile infection: clinical presentation, diagnosis, and management

Bai,

Guo,

Zheng

2023

Therap Adv Gastroenterol

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As a frequent complication of inflammatory bowel disease (IBD), Clostridium difficile infection (CDI) was confirmed to not only aggravate the symptoms of IBD but also result in unexpected outcomes, including death. With the increasing prevalence rate of IBD and the updating of CDI diagnosis, the incidence of CDI in IBD patients is also seen rising. Although a detection method consisting of glutamate dehydrogenase immunoassay or nucleic acid amplification test and then toxin A/B enzyme immunoassay was recommended and widely adopted, the diagnosis of CDI in IBD is still a challenge because of the overlap between the symptoms of CDI in IBD and CDI itself. Vancomycin and fidaxomicin are the first-line therapy for CDI in IBD; however, the treatment has different effects due to the complexity of IBD patients’ conditions and the choice of different treatment schemes. Although the use of fecal microbial transplantation is now in the ascendant for IBD management, the prospects are still uncertain and the prevention and treatment of the recurrence of CDI in IBD remain a clinical challenge. In this paper, the epidemiology, pathophysiology, clinical manifestation, prevention, and therapy of CDI in IBD were summarized and presented.

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Prevalence of Clostridium difficile infection among hospitalized inflammatory bowel disease patients in Greece

Cited by 9 publications

References 23 publications

The interplay of Clostridioides difficile infection and inflammatory bowel disease

The interplay of Clostridioides difficile infection and inflammatory bowel disease

Clinical Features of Crohn’s Disease Stratified by Age at Diagnosis According to Montreal Classification

Inflammatory bowel disease and Clostridium difficile infection: clinical presentation, diagnosis, and management

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