Rising Incidence of Intestinal Infections in Inflammatory Bowel Disease: A Nationwide Analysis

Barber, Grant E.; Hendler, Steven; Okafor, Philip N.; Limsui, David; Limketkai, Berkeley N.

doi:10.1093/ibd/izy086

Cited by 32 publications

(36 citation statements)

References 13 publications

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“…those undergoing surgery, 75,76 and even infants. 41 The results of our systematic review of literature and meta-analysis emphasize the need to perform C difficile surveillance and direct resources to the prevention of CDI in order to reduce the incidence across the United States.…”

Section: Discussionmentioning

confidence: 97%

“…Three studies [40][41][42] included only inpatients ( Table 2). Two of these studies 41,42 assessed the Agency for Healthcare Research and Quality (AHRQ) National Inpatient Sample (NIS). One evaluated infant patients from the AHRQ NIS cohort, 41 and the other study evaluated adult patients from the AHRQ NIS cohort.…”

Section: Introductionmentioning

confidence: 99%

“…Two of these studies 41,42 assessed the Agency for Healthcare Research and Quality (AHRQ) National Inpatient Sample (NIS). One evaluated infant patients from the AHRQ NIS cohort, 41 and the other study evaluated adult patients from the AHRQ NIS cohort. 42 Both studies documented substantial increases in CDI incidence between 2000 and 2005, from 2.8 to 5.1 cases per 10 000 hospitalizations, and from 5.5 to 11.2 cases per 10 000 hospitalizations, respectively.…”

Section: Introductionmentioning

confidence: 99%

“…42 Both studies documented substantial increases in CDI incidence between 2000 and 2005, from 2.8 to 5.1 cases per 10 000 hospitalizations, and from 5.5 to 11.2 cases per 10 000 hospitalizations, respectively. 41,42 The third study, 40 which was from the US National Hospital Discharge Survey between 2001 and 2010, found that the incidence of CDI in the pediatric population was 1.2 CDI discharges per 1000 total discharges.…”

Section: Introductionmentioning

confidence: 99%

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Incidence and Outcomes Associated WithClostridium difficileInfections

et al. 2020

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IMPORTANCE An understanding of the incidence and outcomes of Clostridium difficile infection (CDI) in the United States can inform investments in prevention and treatment interventions. OBJECTIVE To quantify the incidence of CDI and its associated hospital length of stay (LOS) in the United States using a systematic literature review and meta-analysis. DATA SOURCES MEDLINE via Ovid, Cochrane Library Databases via Wiley, Cumulative Index of Nursing and Allied Health Complete via EBSCO Information Services, Scopus, and Web of Science were searched for studies published in the United States between 2000 and 2019 that evaluated CDI and its associated LOS. STUDY SELECTION Incidence data were collected only from multicenter studies that had at least 5 sites. The LOS studies were included only if they assessed postinfection LOS or used methods accounting for time to infection using a multistate model or compared propensity score-matched patients with CDI with control patients without CDI. Long-term-care facility studies were excluded. Of the 119 full-text articles, 86 studies (72.3%) met the selection criteria. DATA EXTRACTION AND SYNTHESIS Two independent reviewers performed the data abstraction and quality assessment. Incidence data were pooled only when the denominators used the same units (eg, patient-days). These data were pooled by summing the number of hospital-onset CDI incident cases and the denominators across studies. Random-effects models were used to obtain pooled mean differences. Heterogeneity was assessed using the I 2 value. Data analysis was performed in February 2019. MAIN OUTCOMES AND MEASURES Incidence of CDI and CDI-associated hospital LOS in the United States. RESULTS When the 13 studies that evaluated incidence data in patient-days due to hospital-onset CDI were pooled, the CDI incidence rate was 8.3 cases per 10 000 patient-days. Among propensity score-matched studies (16 of 20 studies), the CDI-associated mean difference in LOS (in days) between patients with and without CDI varied from 3.0 days (95% CI, 1.44-4.63 days) to 21.6 days (95% CI, 19.29-23.90 days). CONCLUSIONS AND RELEVANCE Pooled estimates from currently available literature suggest that CDI is associated with a large burden on the health care system. However, these estimates should be interpreted with caution because higher-quality studies should be completed to guide future evaluations of CDI prevention and treatment interventions.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence and Outcomes Associated WithClostridium difficileInfections

et al. 2020

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“…Inflammatory bowel diseases, including Crohn's disease and ulcerative colitis, are chronic and progressive diseases characterized by inflammation of the digestive tract. The incidence of C. difficile infection (CDI) has significantly increased among hospitalized patients with inflammatory bowel disease (IBD) over the past two decades (1)(2)(3). C. difficile is a spore-forming bacterium that produces enterotoxins that damage the intestinal epithelium.…”

Section: Introductionmentioning

confidence: 99%

Intestinal inflammation and altered gut microbiota associated with inflammatory bowel disease renders mice susceptible toClostridioides difficilecolonization and infection

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Barron

George

et al. 2020

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Clostridioides difficile has emerged as a noteworthy pathogen in patients with inflammatory bowel disease (IBD). Concurrent IBD and CDI is associated with increased morbidity and mortality compared to CDI alone. IBD is associated with alterations of the gut microbiota, an important mediator of colonization resistance to C. difficile. Here, we describe and utilize a mouse model to explore the role of intestinal inflammation in susceptibility to C. difficile colonization and subsequent disease severity in animals with underlying IBD. Helicobacter hepaticus, a normal member of the mouse gut microbiota, was used to trigger inflammation in the distal intestine akin to human IBD in mice that lack intact IL-10 signaling. Development of IBD resulted in a distinct intestinal microbiota community compared to non-IBD controls. We demonstrate that in this murine model, IBD was sufficient to render mice susceptible to C. difficile colonization. Mice with IBD were persistently colonized by C. difficile, while genetically identical non-IBD controls were resistant to C. difficile colonization. Concomitant IBD and CDI was associated with significantly worse disease than unaccompanied IBD. IL-10-deficient mice maintained gut microbial diversity and colonization resistance to C. difficile in experiments utilizing an isogenic mutant of H. hepaticus that does not trigger intestinal inflammation. These studies in mice demonstrate that the IBD-induced microbiota is sufficient for C. difficile colonization and that this mouse model requires intestinal inflammation for inducing susceptibility to CDI in the absence of other perturbations, such as antibiotic treatment.

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Treatment escalation and de-escalation decisions in Crohn’s disease: Delphi consensus recommendations from Japan, 2021

et al. 2023

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Background We aimed to develop criteria for treatment intensification in patients with (1) luminal Crohn’s disease (CD), (2) CD with perianal disease and/or fistula, (3) CD with small bowel stenosis, (4) in the postoperative setting, and (5) for discontinuing or reducing the dose of treatment in patients with CD. Methods PubMed and Embase were searched for studies published since 1998 which may be relevant to the five defined topics. Results were assessed for relevant studies, with preference given to data from randomized, controlled studies. For each question, a core panel of 12 gastroenterologists defined the treatment target and developed statements, based on the literature, current guidelines, and relevant additional studies. The evidence supporting each statement was graded using the Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009). A modified Delphi process was used to refine statements and gain agreement from 54 Japanese specialists at in-person and online meetings conducted between October 2020 and April 2021. Results Seventeen statements were developed for treatment intensification in luminal CD (targeting endoscopic remission), six statements for treatment intensification in perianal/fistulizing CD (targeting healing of perianal lesions and complete closure of the fistula), six statements for treatment intensification in CD with small bowel stenosis (targeting resolution of obstructive symptoms), seven statements for treatment intensification after surgery (targeting endoscopic remission), and five statements for discontinuing or reducing the dose of treatment in patients with CD. Conclusions These statements provide guidance on how and when to intensify or de-intensify treatment for a broad spectrum of patients with CD.

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Rising Incidence of Intestinal Infections in Inflammatory Bowel Disease: A Nationwide Analysis

Cited by 32 publications

References 13 publications

Incidence and Outcomes Associated WithClostridium difficileInfections

Incidence and Outcomes Associated WithClostridium difficileInfections

Intestinal inflammation and altered gut microbiota associated with inflammatory bowel disease renders mice susceptible toClostridioides difficilecolonization and infection

Treatment escalation and de-escalation decisions in Crohn’s disease: Delphi consensus recommendations from Japan, 2021

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