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. 2018 Sep;33(9):1285-1294.
doi: 10.1007/s00384-018-3105-8. Epub 2018 Jun 21.

Impact of superimposed Clostridium difficile infection in Crohn's or ulcerative colitis flares in the outpatient setting

Patrícia Guedes Garcia  1 , Liliana Andrade Chebli  1 , Tarsila Campanha da Rocha Ribeiro  1 , Pedro Duarte Gaburri  1 , Fabio Heleno de Lima Pace  1 , Kátia Valéria Bastos Dias Barbosa  1 , Lívia Almeida Costa  1 , William de Almeida Cruz  1 , Isabelle Carvalho de Assis  1 , Bernardo Rodriguez Mendes Moraes  1 , Alexandre Zanini  1 , Julio Maria Fonseca Chebli  2
Affiliations

Impact of superimposed Clostridium difficile infection in Crohn's or ulcerative colitis flares in the outpatient setting

Patrícia Guedes Garcia et al. Int J Colorectal Dis. 2018 Sep.

Abstract

Purpose: The prospective assessment of Clostridium difficile infection (CDI) impact in inflammatory bowel disease (IBD) flare in outpatient setting has been poorly investigated. We aimed to evaluate the prevalence and the associated factors with CDI in IBD outpatients presenting colitis flares as well as the outcomes following treatment.

Methods: In this prospective cohort study, conducted from October, 2014, to July, 2016, 120 IBD patients (55% presenting colitis flare) and 40 non-IBD controls were assessed for CDI. Multivariate regression analysis was performed to identify predictors of CDI. Outcome analysis was estimated for recurrent CDI, hospitalization, colectomy, and CDI-associated mortality.

Results: The number of patients with CDI was significantly higher in IBD patients experiencing flares than in both inactive IBD and non-IBD groups (28.8 vs. 5.6 vs. 0%, respectively; p = 0.001). Females (OR = 1.39, 95% CI, 1.13-17.18), younger age (OR = 0.77, 95% CI, 0.65-0.92), steroid treatment (OR = 7.42, 95% CI, 5.17-40.20), and infliximab therapy (OR = 2.97, 95% CI, 1.99-24.63) were found to be independently associated with CDI. There was a dose-related increase in the risks of CDI on patients which had taken prednisone. Those treated with vancomycin had a satisfactory response to therapy, but 21% presented recurrent CDI and 16% were hospitalized. Neither necessity of colectomy nor mortality was noticed in any patient during the investigation.

Conclusions: In IBD outpatients presenting colitis flares, CDI is highly prevalent. Females, younger age, infliximab, and notably steroid therapy were independently associated with CDI. Most patients with CDI experienced mild-to-moderate disease, and prompt treatment with vancomycin was highly effective, which seems to reduce the serious complication risks.

Keywords: Clostridium difficile; Colitis; Crohn’s disease; Inflammatory bowel disease; Ulcerative colitis.

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