The incidence and outcomes from <i>Clostridium difficile</i> infection in hospitalized adults with inflammatory bowel disease

Saffouri, George; Gupta, Arjun; Loftus, Edward V.; Baddour, Larry M.; Pardi, Darrell S.; Khanna, Sahil

doi:10.1080/00365521.2017.1362466

Cited by 23 publications

(35 citation statements)

References 43 publications

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“… 8 A similar study analyzed patients with CDI and IBD using the National Hospital Discharge Survey (NHDS) database from 2005 to 2009. 9 The overall incidence of CDI was 369.8/10,000 IBD hospital admissions, where the incidence in UC admissions was 445.6/10,000 and was significantly higher than Crohn’s disease at 220.3/10,000 admissions ( p < 0.0001).…”

Section: The Burden Of CDI In Ibdmentioning

confidence: 91%

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: The Burden Of CDI In Ibdmentioning

confidence: 91%

The interplay of Clostridioides difficile infection and inflammatory bowel disease

Sehgal

Yadav

Khanna

2021

Therap Adv Gastroenterol

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“…Moreover, there is a high prevalence of CDI in asymptomatic patients with IBD . CDI can also influence the disease course of IBD, increase the healthcare costs, and is associated with a worse clinical outcome …”

Section: Introductionmentioning

confidence: 99%

High incidence and morbidity of Clostridium difficile infection among hospitalized patients with inflammatory bowel disease: A prospective observational cohort study

Chen

Deng

Wan

et al. 2019

J of Digest Diseases

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Objective: To investigate the clinical features of Clostridium difficile infection (CDI) in hospitalized patients with inflammatory bowel disease (IBD) and to analyze the impact of CDI on IBD.Methods: A prospective study on patients newly diagnosed with IBD was conducted at the IBD center at Sir Run Run Shaw Hospital from March 2015 to May 2016. Stool samples for anaerobic culture and polymerase chain reaction were used to test CDI and to detect the different toxins in the groups. The patients were followed up for 2 years.Results: Altogether 230 patients with IBD were enrolled, including 77 with ulcerative colitis (UC) and 153 with Crohn's disease (CD). The incidence rate of CDI was 13.9% (32/230). Patients with UC were more susceptible to CDI than those with CD (24.7% vs 8.5%, P < 0.01). Among UC patients, a long disease course, prior hospitalization, proton pump inhibitor use, and disease severity were associated with an increased risk of CDI (all P < 0.05). CDI prolonged hospital stay and increased the rate of longterm surgery rate in UC (both P < 0.05). Among patients with CD, CDI increased both short-and long-term surgery rates during the 2-year follow-up (P < 0.05) and increased repeated hospitalization in the follow-up study (odds ratio 2.41, P = 0.02).Conclusions: A high incidence rate of CDI in patients hospitalized with IBD was related with longer hospital stay and higher surgery rates in our center. Patients with UC are more vulnerable to CDI than those with CD. K E Y W O R D SClostridium difficile, Crohn disease, inflammatory bowel diseases, surgery, ulcerative colitis CDI can also influence the disease course of IBD, increase the healthcare costs, and is associated with a worse clinical outcome. 15,16 To our knowledge, few prospective long-term follow-up studies have been conducted to clarify the course of IBD patients infected with C. difficile either in China or worldwide. A recent study on the epidemiology of CDI in mainland China reported the CDI incidence rates of 12.7% in patients with Crohn's disease (CD) and 19.3% in those with ulcerative colitis (UC). 13 Many studies have found that IBD patients infected with C. difficile have several distinct characteristics when compared with non-IBD CDI patients, including being relatively young, the infection was more likely acquired in the community, and they had not been exposed to antibiotics or to long-term immunosuppressant or steroid therapy. 8,11,17,18 The aim of this prospective study was to evaluate the epidemiological characteristics of hospitalized IBD patients with CDI and to evaluate the impacts of CDI on IBD in our center.Relatively young age of the patients with IBD and outpatient groups with CDI were considered as possible reasons. In this study, antibiotic use was not an independent risk factor for CDI in patients with IBD, as it may be attributable to the short-term use of antibiotics and a relatively small percentage of patients who used antibiotics. Whether the use of glucocorticoids and immunosuppressants are risk factors of CDI in p...

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“…Longer the period of hospitalization and higher the severity of the disease, greater was the risk of C. difficile infection among patients in a hospital setting. Moreover, we observed that C. difficile infection in patients with IBD affects the clinical course of IBD and increases the length of hospitalization [ 26 ]. Therefore, it is important in clinical practice to adopt systematized strategies to prevent the vicious cycle of recurrent C. difficile infection superimposed on the disease course in PIBD patients.…”

Section: Discussionmentioning

confidence: 99%

Clostridium difficile Infection at Diagnosis and during the Disease Course of Pediatric Inflammatory Bowel Disease

Kim

Cho

Yang

2018

Pediatr Gastroenterol Hepatol Nutr

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Purpose: Clostridium difficile colonization and infection are commonly associated with poor outcomes in patients with pediatric inflammatory bowel disease (PIBD). We aimed to investigate the prevalence of C. difficile colonization and infection at the time of diagnosis and to evaluate risk factors associated with the development of C. difficile infection during the course of PIBD treatment. Methods: We retrospectively enrolled a total of 59 children who were newly diagnosed with PIBD at the tertiary medical center. All patients underwent C. difficile toxin assays and cultures initially and at every follow-up during the disease course. Kaplan-Meier survival analysis and Cox regression test were used for statistical analysis. Results: Initial cultures for C. difficile were positive in 13 (22.0%) of 59 PIBD patients, whereas initial toxin assays were positive in 3 patients (5.1%). During treatment, C. difficile cultures converted to positive in 28 (47.5%) in addition to 13 patients who were initially culture-positive, and C. difficile toxins converted to positive in 13 (22.0%) in addition to 3 originally toxin-positive patients. Antibiotic usage alone was significantly associated with the development of C. difficile colonization (p=0.011), and the length of hospitalization was associated with the development of C. difficile infection (p=0.032). Conclusion: C. difficile colonization and infection occur frequently during the disease course of PIBD. Antibiotic usage and longer hospital stay were significant risks factors for the conversion of C. difficile status in PIBD patients undergoing treatment.

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The incidence and outcomes from Clostridium difficile infection in hospitalized adults with inflammatory bowel disease

Abstract: CDI in IBD patients prolonged hospitalization and increased in-hospital mortality and likelihood of dismissal to a care-facility as compared to IBD patients without CDI. CDI was more common among African-American IBD patients compared to IBD patients of other races.

Cited by 23 publications

References 43 publications

The interplay of Clostridioides difficile infection and inflammatory bowel disease

The interplay of Clostridioides difficile infection and inflammatory bowel disease

High incidence and morbidity of Clostridium difficile infection among hospitalized patients with inflammatory bowel disease: A prospective observational cohort study

Clostridium difficile Infection at Diagnosis and during the Disease Course of Pediatric Inflammatory Bowel Disease

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