Clostridium difficile Infection and Inflammatory Bowel Disease: A Review

Abstract

The incidence of Clostridium difficile infection (CDI) has significantly increased in the last decade in the United States adding to the health care burden of the country. Patients with inflammatory bowel disease (IBD) have a higher prevalence of CDI and worse outcomes. In the past, the traditional risk factors for CDI were exposure to antibiotics and hospitalizations in elderly people. Today, it is not uncommon to diagnose CDI in a pregnant women or young adult who has no risk factors. C. difficile can be detected at the initial presentation of IBD, during a relapse or in asymptomatic carriers. It is important to keep a high index of suspicion for CDI in IBD patients and initiate prompt treatment to minimize complications. We summarize here the changing epidemiology, pathogenesis, risk factors, clinical features, and treatment of CDI in IBD.

Figure 1

Treatment failure rates (%) of metronidazole in C. difficle infection: The rate of treatment failure with metronidazole has increased over the last 2 decades. Metronidazole treatment failure rates (%) however have increased the most after 2000 with the emergence of hypervirulent NAP1/B1/027 strain [66, 67, 69, 70, 78].