Faculty Collaboration Database

Impact of Clostridium difficile on inflammatory bowel disease. Clin Gastroenterol Hepatol 2007 Mar;5(3):345-51

Date

03/21/2007

Pubmed ID

17368234

DOI

10.1016/j.cgh.2006.12.028

Scopus ID

2-s2.0-33947111354 (requires institutional sign-in at Scopus site)   473 Citations

Abstract

BACKGROUND & AIMS: Clostridium difficile-associated disease has increased significantly in North American medical centers. The impact of C difficile on patients with IBD (Crohn's disease, ulcerative colitis) at the present time is unknown.

METHODS: A retrospective, observational study evaluating IBD patients followed in a referral center to evaluate the impact of C difficile was performed. Diagnosis was confirmed with stool toxin analysis. Demographic information, diagnosis, anatomic location, IBD therapy, antibiotic exposure, hospitalizations, and surgeries were recorded. Available endoscopic and histologic data were evaluated.

RESULTS: Rate of C difficile infection increased from 1.8% of IBD patients in 2004 to 4.6% in 2005 (P < .01). Proportion of IBD patients within the total number of C difficile infections at our institution increased from 7% in 2004 to 16% in 2005 (P < .01). IBD colonic involvement was found in the majority of C difficile-infected patients in 2005 (91%), and the majority contracted infection as an outpatient (76%). Antibiotic exposure was identified in 61% of IBD patients with C difficile infection in 2005. Pseudomembranes and fibrinopurulent eruptions were not seen endoscopically or histologically. During 2004-2005 more than half of the infected IBD patients required hospitalization, and 20% required colectomy. Univariate and multivariate analysis identified maintenance immunomodulator use and colonic involvement as independent risk factors for C difficile infection in IBD.

CONCLUSIONS: C difficile infection has increased significantly in IBD patients and negatively impacts clinical outcome. Increased vigilance regarding this infection in IBD patients with colitis activity is warranted.

Author List

Issa M, Vijayapal A, Graham MB, Beaulieu DB, Otterson MF, Lundeen S, Skaros S, Weber LR, Komorowski RA, Knox JF, Emmons J, Bajaj JS, Binion DG

Authors

Mary Beth Graham MD Associate Chief, Professor in the Medicine department at Medical College of Wisconsin
Sarah J. Lundeen NP APP Outpatient in the Surgery department at Medical College of Wisconsin
Mary F. Otterson MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Age Distribution
Analysis of Variance
Clostridium Infections
Colitis, Ulcerative
Comorbidity
Crohn Disease
Diarrhea
Feces
Female
Humans
Incidence
Inflammatory Bowel Diseases
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Probability
Prognosis
Retrospective Studies
Risk Assessment
Severity of Illness Index
Sex Distribution