Risk Factors Associated with<i>Clostridium difficile</i>Infection in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Balram, Bhairavi; Battat, Robert; Khoury, Alex Al; D’Aoust, Julie; Afif, Waqqas; Bitton, Alain; Lakatos, László; Bessissow, Talat

doi:10.1093/ecco-jcc/jjy143

Cited by 52 publications

(43 citation statements)

References 53 publications

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“…Patients who received antibiotics within the first year of life were 2.9 times more likely to develop IBD than those who did (95% CI: 1.2-7.0). Moreover, Balram et al found that antibiotics use within 30 days of diagnosis appeared to increase the risk of clostridium difficile infection (CDI) among IBD patients (OR = 1.85, 95% CI: 1.36-2.52) (138). Therefore, further emphasis should be attached to the management of antibiotics use.…”

Section: Antibioticsmentioning

confidence: 99%

Treatment of Inflammatory Bowel Disease: A Comprehensive Review

2021

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Inflammatory bowel disease (IBD), as a global disease, has attracted much research interest. Constant research has led to a better understanding of the disease condition and further promoted its management. We here reviewed the conventional and the novel drugs and therapies, as well as the potential ones, which have shown promise in preclinical studies and are likely to be effective future therapies. The conventional treatments aim at controlling symptoms through pharmacotherapy, including aminosalicylates, corticosteroids, immunomodulators, and biologics, with other general measures and/or surgical resection if necessary. However, a considerable fraction of patients do not respond to available treatments or lose response, which calls for new therapeutic strategies. Diverse therapeutic options are emerging, involving small molecules, apheresis therapy, improved intestinal microecology, cell therapy, and exosome therapy. In addition, patient education partly upgrades the efficacy of IBD treatment. Recent advances in the management of IBD have led to a paradigm shift in the treatment goals, from targeting symptom-free daily life to shooting for mucosal healing. In this review, the latest progress in IBD treatment is summarized to understand the advantages, pitfalls, and research prospects of different drugs and therapies and to provide a basis for the clinical decision and further research of IBD.

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Section: Antibioticsmentioning

confidence: 99%

Treatment of Inflammatory Bowel Disease: A Comprehensive Review

2021

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“… 11 Other risk factors include immunosuppression, chemotherapy, acid reduction therapy, prior C. difficile infection, hospitalization, stays in a long-term care facility, and surgeries. 12 , 13 …”

Section: Pathogenesismentioning

confidence: 99%

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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“…To our knowledge, this study is the first meta-analysis and systematic review to explore the risk factors of CDI in pediatric IBD patients, and assess the impact of CDI on IBD regarding rate of bowel surgery, which is different from that of adults [16].…”

Section: Discussionmentioning

confidence: 99%

“…To date, most studies have demonstrated the risk factors of CDI with IBD in adult patients. In a meta-analysis study, antibiotic use within 30 days, colonic involvement in Crohn's disease (CD) patients, and use of biologics were associated with increased CDI rates [16]. In the pediatric population, conflicting evidence existed when examining potential risk factors for CDI.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for Clostridioides difficile infection in children and adolescents with inflammatory bowel disease: a systematic review and meta-analysis

et al. 2021

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Background Risk factors and consequences associated with Clostridioides difficile infection (CDI) in children and adolescents with inflammatory bowel disease (IBD) are still uncertain. We conduct a systematic review and meta-analysis to assess risk factors and outcomes associated with CDI in children and adolescents with IBD. Methods PubMed, EMBASE and Cochrane Library databases were searched from inception to 24th February, 2021. Studies investigating risk factors, bowel surgery rate in pediatric IBD patients with and without CDI were included. Random-effects model was used for calculating summary estimates. Newcastle-Ottawa scale (NOS) was used for quality assessment. Results Fourteen studies, comprising 17,114 patients, were included. There was a significant association between 5-aminosalicylic acid (5-ASA) use and CDI [odds ratio (OR) = 1.95, 95% confidence interval (CI) 1.26-3.03], with minimal heterogeneity (I 2 = 0.00%). Increased risk of active disease (OR = 4.66, 95% CI 2.16-10.07) were associated with CDI in those studies performed in high quality score (NOS > 6) and significantly higher CDI rates in studies conducted outside USA (OR = 2.94, 95% CI 1.57-5.58). The bowel surgery rate in IBD with CDI was 3.8-57.1%, compared to that in IBD without CDI (0-21.3%). All studies were of moderate to high quality. Conclusions 5-ASA use and active disease might be risk factors associated with CDI in children and adolescents with IBD. Bowel surgery rates associated with CDI in IBD patients varied greatly. Large-scale clinical studies on CDI in children and adolescents with IBD are still needed to verify risk factors and outcomes.

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Risk Factors Associated withClostridium difficileInfection in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Abstract: Colonic involvement, biologic and antibiotic use appear to be risk factors associated with CDI amongst IBD patients. CDI is associated with increased short and long-term mortality.

Cited by 52 publications

References 53 publications

Treatment of Inflammatory Bowel Disease: A Comprehensive Review

Treatment of Inflammatory Bowel Disease: A Comprehensive Review

The interplay of Clostridioides difficile infection and inflammatory bowel disease

Risk factors for Clostridioides difficile infection in children and adolescents with inflammatory bowel disease: a systematic review and meta-analysis

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