The interplay of Clostridioides difficile infection and inflammatory bowel disease

Abstract

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.

Clostridium Difficile and COVID-19: General Data, Ribotype, Clinical Form, Treatment-Our Experience from the Largest Infectious Diseases Hospital in Western Romania

“…In our study, an extremely high percentage of COVID-19 patients received broad-spectrum of antibiotics prior to and during their hospital stay. Similar percentages have been reported by Sehgal et al and Khanna et al in the first half of 2021 [32,33]. Azithromycin was the most frequently prescribed antibiotic for outpatient treatment of COVID-19 as empirical coverage for possible superinfection of the respiratory tract and thus, independently associated with the risk of developing CDI.…”

Risk Factors, Diagnosis, and Management of Clostridioides difficile Infection in Patients with Inflammatory Bowel Disease

“…Performing stool microbiology on specimens obtained from IBD patients in a flare-up, a study demonstrated that 10.5% of these relapses were associated with intestinal infections, half of them (and the most abundant one) being CDI [22]. In addition, recent evidence further supports the fact that CDI is the most common complication in IBD patients, leading to a flare-up [25][26][27].…”

The Current Knowledge on Clostridioides difficile Infection in Patients with Inflammatory Bowel Diseases

“…A tapered and pulsed vancomycin regimen, vancomycin in standard dosage 10 days followed by rifaximin 400 mg TID for 20 days, fidaxomicin 200 mg BID for 10 days, and vancomicin or fidaxomicin followed by fecal microbiota transplantation (FMT), represent therapeutic choices in recurrent infection [ 24 , 123 ]. Data supporting the efficacy of prolonged oral vancomycin therapy in IBD result from a study performed by Lei et al, who found lower rates of CDI recurrence as a result of long-duration therapy (21–42 days), comparing with short-duration vancomycin therapy (10–14 days) [ 124 ].…”