Risk Factors and Outcome of PCR-detected Clostridium difficile Infection in Ileal Pouch Patients

Li, Yue; Qian, Jiaming; Queener, Elaine; Shen, Bo

doi:10.1097/mib.0b013e318280fcb9

Cited by 56 publications

(33 citation statements)

References 43 publications

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“…In adult UC inpatients, the incidence of CDI ranges from 2.8% to 11.1%[26-32]. In adult outpatients with ileal-anal pouch anastomosis (IPAA) for IBD, incidence of CDI is 10.7%-18.3%[33,34]. The incidence of CDI in IBD among pediatric patients is 7.8%-69%, similarly with a higher incidence among patients with UC as opposed to CD[35-40].…”

Section: Discussionmentioning

confidence: 99%

Management of inflammatory bowel disease withClostridium difficileinfection

D’Aoust

Battat

Bessissow

2017

WJG

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AIMTo address the management of Clostridium difficile (C. difficile) infection (CDI) in the setting of suspected inflammatory bowel disease (IBD)-flare.METHODSA systematic search of the Ovid MEDLINE and EMBASE databases by independent reviewers identified 70 articles including a total of 932141 IBD patients or IBD-related hospitalizations.RESULTSIn those with IBD, CDI is associated with increased morbidity, including subsequent escalation in IBD medical therapy, urgent colectomy and increased hospitalization, as well as excess mortality. Vancomycin-containing regimens are effective first-line therapies for CDI in IBD inpatients. No prospective data exists with regards to the safety or efficacy of initiating or maintaining corticosteroid, immunomodulator, or biologic therapy to treat IBD in the setting of CDI. Corticosteroid use is a risk factor for the development of CDI, while immunomodulators and biologics are not.CONCLUSIONStrong recommendations regarding when to initiate IBD specific therapy in those with CDI are precluded by a lack of evidence. However, based on expert opinion and observational data, initiation or resumption of immunosuppressive therapy after 48-72 h of targeted antibiotic treatment for CDI may be considered.

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Section: Discussionmentioning

confidence: 99%

Management of inflammatory bowel disease withClostridium difficileinfection

D’Aoust

Battat

Bessissow

2017

WJG

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“…Recent studies conducted in Chinese healthcare settings have mainly focused on the antimicrobial resistance of strains or the risk factors and molecular epidemiology of CDI [26][27][28][29]. Currently, there are no wellestablished diagnostic procedures for CDI in our country, due to a lack of clinical awareness.…”

Section: Discussionmentioning

confidence: 99%

Clinical characterization and risk factors of Clostridium difficile infection in elderly patients in a Chinese hospital

Zhang

Dong

Jiang

et al. 2015

J Infect Dev Ctries

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Introduction: Clostridium difficile is a common cause of nosocomial diarrhea, especially in elderly patients. This study aimed to analyze the clinical features and assess the risk factors associated with Clostridium difficile infection (CDI) in elderly hospitalized patients. Methodology: A retrospective case-control study was conducted among elderly hospitalized patients (> 60 years of age) in a Chinese tertiary hospital between 2010 and 2013. Fifty-two CDI patients and 150 randomly selected non-CDI patients were included in the study. Clinical features of CDI and non-CDI patients were compared by appropriate statistical tests. Logistic regression analyses were performed on a series of factors to determine the risk factors for CDI among the elderly hospitalized patients. Results: The elderly CDI patients showed higher leukocyte counts, lower serum albumin levels, longer duration of hospital stay, and higher mortality compared to the non-CDI patients. The proportion of patients admitted to the intensive care unit or exposed to gastric acid suppressants was also significantly different (p < 0.05) between the two groups. Multivariate analysis indicated that serum creatinine (OR 1.004; 95% CI 1.001-1.008), surgical intervention (OR 6.132; 95% CI 2.594-14.493), the number of comorbidities (OR 2.573; 95% CI 1.353-4.892), gastrointestinal disease (OR 4.670; 95% CI 2.002-10.895), and antibiotic use (OR 6.718; 95% CI 2.846-15.859) were independently associated with CDI. Conclusions: This study revealed several risk factors for CDI among elderly hospitalized patients. These findings will increase the knowledge concerning this disease and provide information regarding the control and prevention of CDI in the elderly.

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“…However, there are two situations in which C. difficile can affect the small bowel: (A) it rarely causes enteritis in patients with an ileostomy, resulting in highvolume watery ileostomy output as well as an ileus-type clinical picture; 11 (B) C. difficile has been associated with up to 10-18 % of cases of recurrent pouchitis in patients after procto-colectomy and ileal pouch-anal anastomosis (IPAA). 115 In both situations, a specific antibiotic treatment will need to be initiated (metronidazole, vancomycin, fidaxomycin) to control the symptoms.…”

Section: Inflammatory Bowel Disease and CDImentioning

confidence: 99%

Clostridium Difficile Infection from a Surgical Perspective

Kaiser

Hogen

Bordeianou

et al. 2015

Journal of Gastrointestinal Surgery

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Prevention, containment, and non-surgical treatment are the cornerstone of management for CDI. However, the most severe forms with toxic colitis benefit from involvement of a surgical team. Swift open total abdominal colectomy with end ileostomy in patients with severe or fulminant C. difficile colitis has the best chance to reduce mortality if it is not delayed until shock, end organ damage, vasopressor requirement, mental status changes develop. Less aggressive approaches may be appropriate for milder and refractory forms but require further study before their applicability can be determined.

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Risk Factors and Outcome of PCR-detected Clostridium difficile Infection in Ileal Pouch Patients

Abstract: A high index of suspicion for CDI in pouch patients should be given to those with recent hospitalization or constitutional symptoms, such as weight loss. Recurrent or refractory CDI is common, even with standard oral vancomycin therapy.

Cited by 56 publications

References 43 publications

Management of inflammatory bowel disease withClostridium difficileinfection

Management of inflammatory bowel disease withClostridium difficileinfection

Clinical characterization and risk factors of Clostridium difficile infection in elderly patients in a Chinese hospital

Clostridium Difficile Infection from a Surgical Perspective

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