scholarly journals Clostridioides difficile Enteritis in Patients Following Total Colectomy—a Rare but Genuine Clinical Entity

2019 ◽  
Vol 6 (11) ◽  
Author(s):  
Robert J Ulrich ◽  
Jonathan Bott ◽  
Hannah Imlay ◽  
Kerri Lopez ◽  
Sandro Cinti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Total Colectomy ◽  
Severe Disease ◽  
Clinical Entity ◽  
Acid Suppression ◽  
Clostridioides Difficile ◽  
Inflammatory Bowel ◽  
One Year

Clostridioides difficile enteritis (CDE) after colectomy is an understudied infectious syndrome. We reviewed 20 years of post-colectomy data and found CDE in 44/855 (5.1%) patients, usually within one year of surgery. Risk factors include acid suppression, inflammatory bowel disease, and antibiotics with enteral feeds. Clostridioides difficile enteritis often presents with severe disease requiring hospitalization.

scholarly journals Risk factors for developing high-output ileostomy in CRC patients: a retrospective study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dongxiao Bai ◽  
Lei Li ◽  
Zhiling Shen ◽  
Tianchen Huang ◽  
Qingbing Wang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Multivariate Analysis ◽  
Anastomotic Leakage ◽  
Bowel Disease ◽  
Total Colectomy ◽  
Abdominal Infection ◽  
Inflammatory Bowel ◽  
High Output

Abstract Background Anastomotic leakage is one of the most serious postoperative complications of rectal cancer. Prophylactic ileostomy has been widely used to reduce the risk and severity of complications of anastomotic leakage. However, prophylactic ileostomy itself has some complications, and ileostomy high output syndrome (HOS) is one of them. This study was performed to explore the risk factors of HOS in ileostomy. Methods A total of 114 patients with HOS were screened out from 494 eligible ileostomy patients in the last 5 years. The relationship between HOS and the clinicopathological data was analyzed using the Chi-square test and Fisher’s exact probability. Multivariate analysis was performed by logistic regression. Results The incidence of HOS was 23.07% in this study. Dehydration was the most common symptom of HOS (37.7%). There was no clear correlation between HOS occurrence with sex, age, gross typing, histological grade, tumor location, lymph node metastasis, and TNM stage (p > 0.05). The incidence of HOS was 14/18 in inflammatory bowel disease patients, 18/28 in diabetes mellitus patients, and 23/72 in neoadjuvant chemoradiotherapy patients, 13/17 in total colectomy and abdominal infection patients. Multivariate analysis showed that they are risk factors for HOS (p < 0.05). Conclusion HOS occurred occasionally but rarely studied and lacks attention. Inflammatory bowel disease, diabetes mellitus, neoadjuvant radiotherapy chemotherapy, total colectomy and abdominal infection are the risk factors for HOS.

scholarly journals Characteristics of Clostridioides difficile infection in inflammatory bowel disease

2020 ◽  
Author(s):  
Chenjie Tang ◽  
Chengcheng Liu ◽  
Yaping Han ◽  
Xiaohui Zhang ◽  
Wenying Xia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Molecular Epidemiology ◽  
Bowel Disease ◽  
Treatment Plan ◽  
Clostridioides Difficile ◽  
Quinolone Antibiotics ◽  
Inflammatory Bowel ◽  
Independent Risk Factors ◽  
And Gender

Abstract Background: The epidemiology of Clostridioides difficile infection(CDI) in China is different from western countries and the characteristics of CDI among inflammatory bowel disease (IBD) in China may be unique. The aim of this study was to investigate the molecular epidemiology and to find out the risk factors of CDI among IBD inpatients in Jiangsu Province, China. Methods: Patients with IBD admitted to the First Affiliated Hospital with Nanjing Medical University from August 2013 to December 2018 were enrolled. IBD patients were matched with non IBD patients according to age and gender. Diarrhea samples were sent for CDI diagnosis and the molecular epidemiology investigation was performed. Finally, patients’ information was collected and logistic regression analysis was performed to analyze the independent risk factors of CDI in IBD patients. Results: In this study, the incidence of CDI in IBD patients was much higher than that in non IBD patients (24.6% vs. 9.0%) and community acquired infection was the main kind. The predominant type of epidemic strain of C. difficile in this study was ST54. The shorter history of IBD and recent use of quinolone antibiotics were independent risk factors for CDI among diarrhea patients with IBD. Conclusion: If the duration of IBD is within one year or quinolone antibiotics have been used recently, clinicians should consider the possibility of IBD patients complicated with CDI and adjust the treatment plan.

scholarly journals Risk factors for developing high-output ileostomy: a retrospective study

2021 ◽  
Author(s):  
Xiao Jian'an ◽  
Dongxiao Bai ◽  
Lei Li ◽  
Zhiling Shen ◽  
Tianchen Huang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Colorectal Cancer ◽  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Total Colectomy ◽  
Neoadjuvant Chemoradiotherapy ◽  
Clear Correlation ◽  
Abdominal Infection ◽  
Inflammatory Bowel

Abstract Background Prophylactic ileostomy and colostomy have been widely used to reduce the risk and complications of anastomotic leakage with high-risk colorectal cancer after operation. However, prophylactic ileostomy itself has some complications, and ileostomy high out-put syndrome is one of them. This study was performed to explore the risk factors of HOS in ileostomy.Methods A total of 114 patients with HOS were screened out from 494 eligible ileostomy patients in the last five years. The clinical and pathological data were analyzed. The relationship between HOS and clinicopathological data was analyzed. Multivariate analysis was performed by logistic regression.Results There was no clear correlation between the occurrence of HOS with sex, age, gross typing, histological grade, location of tumors, lymph node metastasis and TNM stage (p>0.05). Preoperative complications including inflammatory bowel disease, diabetes mellitus and neoadjuvant chemoradiotherapy were risk factors for HOS (p<0.05). Total colectomy and abdominal infection were risk factors for HOS (p<0.05) during operation.Conclusion Inflammatory bowel disease, diabetes mellitus and neoadjuvant radiotherapy and chemotherapy in patients with colorectal cancer are the preoperative risk factors for HOS. Total colectomy and postoperative abdominal infection are the postoperative risk factors for HOS.

scholarly journals Novel risk factors and outcomes in inflammatory bowel disease patients with Clostridioides difficile infection

2021 ◽  
Vol 14 ◽  
pp. 175628482199779
Author(s):  
Elida Voth ◽  
Dipesh Solanky ◽  
Edward V. Loftus ◽  
Darrell S. Pardi ◽  
Sahil Khanna
Keyword(s):  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Adverse Outcomes ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Clostridioides Difficile Infection ◽  
Inflammatory Bowel ◽  
Antidepressant Use ◽  
Statin Use

Background: Patients with inflammatory bowel disease (IBD) are at significantly increased risk for Clostridioides difficile infection (CDI) with an increased risk of adverse outcomes including increased in-hospital mortality, IBD treatment failure, re-hospitalization, and high CDI recurrence rates. The existing literature on predictors of these adverse outcomes is limited. We evaluated four potentially modifiable novel risk factors [body mass index (BMI), statin use, opioid use, and antidepressant use] on CDI risk and adverse outcomes in these patients. Methods: Using a retrospective design, variables were abstracted from records for patients with IBD and CDI from 2008 to 2013. Statistical analysis comprised descriptive statistics and univariate and multivariate logistic regression analyses. Results: There were 137 patients with IBD and CDI included in this study. On multivariate analysis controlling for age, 43% of patients in the overweight BMI category had severe or severe, complicated CDI, compared with 22% of patients in the underweight/normal BMI [odds ratio (OR) 2.85, p = 0.02] and 19% in the obese category (OR 3.95, p = 0.04). Statin use was associated with severe or severe, complicated CDI when controlling for age and BMI (OR 5.66, p = 0.01). There was no association between statin use and IBD exacerbations following CDI. Opioid and antidepressant use were not associated with disease severity or frequency of IBD exacerbations following CDI. Conclusions: An overweight BMI and statin use were associated with severe or severe, complicated CDI in IBD patients. Further studies are needed to better understand how these factors impact management of patients with IBD to improve clinical outcomes and potentially reduce the risk of complications from CDI.

scholarly journals Prevalence of Malnutrition, Its Risk Factors, and the Use of Nutrition Support in Patients with Inflammatory Bowel Disease

2022 ◽  
Author(s):  
Jing Liu ◽  
Xiaolong Ge ◽  
Chunhui Ouyang ◽  
Dongxu Wang ◽  
Xiaoqi Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Severe Disease ◽  
Nutrition Support ◽  
Chinese Patients ◽  
Nutrient Deficiencies ◽  
Cross Sectional ◽  
Essential Components ◽  
Inflammatory Bowel

Abstract Background Malnutrition is prevalent among patients with inflammatory bowel disease (IBD). Nutritional profiles among Asian patients with IBD have seldom been investigated. We assessed the prevalence of and risk factors for malnutrition, use of nutrition support, and sociopsychological status associated with malnutrition among patients with IBD in China. Methods Patients with ulcerative colitis (UC) and Crohn’s disease (CD) recruited from 43 tertiary referral hospitals were screened for malnutrition and nutrient deficiencies in this cross-sectional study. The use of nutrition support was recorded. The sociopsychological status was assessed by subjective questionnaires. Factors associated with malnutrition were analyzed, and multivariate regression was used to determine independent predictors for malnutrition. Results We recruited 1013 patients with a median age of 35.0 years, 58.5% of them had CD, and 61.4% of all patients were male. Overall, 49.5% (501) of patients were diagnosed with malnutrition, including 57.0% of patients with CD, 38.8% of patients with UC, and 44.1% of patients with quiescent or mildly active disease. Nutrient deficiencies were prevalent despite the absence of malnutrition. Malnutrition was associated with adverse sociopsychological status, including decreased social support, higher perceived stress, and impaired quality of life. Moderate to severe disease activity and extensive disease were two independent risk factors for malnutrition. In total, 41.6% of patients received nutrition support, and patients with risk factors were more likely to receive nutrition support. Conclusions Malnutrition was highly prevalent and associated with adverse consequences in Chinese patients with IBD. Malnutrition screening and early initiation of nutrition support are essential components in IBD care.

scholarly journals P473 Ustekinumab and vedolizumab influence on cardiovascular risk factors in patients with Inflammatory Bowel Disease

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S462-S463
Author(s):  
C Amiama Roig ◽  
C Suárez Ferrer ◽  
J Poza Cordón ◽  
J L Rueda García ◽  
M Sánchez Azofra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Cardiovascular Risk ◽  
Lipid Profile ◽  
Cardiovascular Risk Factors ◽  
Bowel Disease ◽  
Clinical Remission ◽  
Number Of Patients ◽  
Inflammatory Bowel ◽  
One Year

Abstract Background Chronic inflammatory diseases, including the Inflammatory Bowel Disease (IBD), show an increased risk in the development of atherosclerotic cardiovascular disease and coronary microvascular dysfunction at an early age. AntiTNF α have proven to be effective in reducing the cardiovascular risk in these malaises, nevertheless due to their mechanism of action, we cannot determine whether such efficacy is due to an adequate inflammation control or due to the specific cytokine blockade, which plays an important role in both the inflammation and the atherogenic process. Taking this into account, our hypothesis assesses whether using other anti-inflammatory therapies, such as Ustekinumab and Vedolizumab, would achieve a decrease in cardiovascular risk. Methods In this observational and retrospective study, we collected cardiovascular risk factors(CVRFs) in 46 patients, immediately before starting Ustekinumab or Vedolizumab and a year after, taking into account if patients were in clinical remission or not. The CVRFs included were: body mass index (BMI), arterial hypertension, triglycerides values, lipid profile, albumin and C-reactive protein. Results 46 patients were included, 33(71.74%) with Crohn and 13(28.26%) with Ulcerative Colitis. Of the total number of patients 25(54.35%) were treated with Ustekinumab and 21(45.65%) with Vedolizumab. During the follow-up, only one patient(0.02%) presented a new cardiovascular event. Paired student’s t-test were used for data analysis in both treatment groups, comparing the values of the different CVRFs at the baseline and after one year of treatment. When comparing these values according to clinical remission at one year, no statistically significant differences were observed for any of them. BMI and weight values were |24.49(DE 4.58) vs 24.93(DE 4.74) p=0,71| and |70.76kg(DE 13.86) vs 71.38kg(DE 13.33) p=0,85| respectively. As for hypertension, no relevant changes were observed, representing 15.22% of the population at the beginning and 17.39% after one year of treatment. The differences observed in blood glucose values were|86.23(81.87–90.6)mg/dL vs 89.87mg/dL(84.72–95.01) p=0,27|. Regarding the lipid profile, the total cholesterol values were 158.58mg/dL(DE 36.5) and 168.69mg/dL(DE 32.72) p=0.18. HDL at the beginning 44.67mg/dL(DE 11.69) and after one year 47.43mg/dL(DE 10.19) p=0.28 and triglycerides values of 126.65mg/dL(DE 56.38) and 133.5mg/dL(DE 60.95) p=0,61. Albumin levels|4.08g/dL(DE 0.39) vs 4.27g/dL(DE 0.27)|did show significant differences (p=0,01). Conclusion Patients treated with Vedolizumab or Ustekinumab do not present a significative reduction in the cardiovascular risk after one year regardless of clinical remission.

IMPACT OF TIME-TO-TEST FOR CLOSTRIDIOIDES DIFFICILE INFECTION ON LENGTH OF STAY IN INFLAMMATORY BOWEL DISEASE PATIENTS HOSPITALIZED WITH FLARE

2021 ◽  
Vol 27 (Supplement_1) ◽  
pp. S50-S50
Author(s):  
Abhishek Verma ◽  
Sanskriti Varma ◽  
Daniel Freedberg ◽  
David Hudesman ◽  
Shannon Chang ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Length Of Stay ◽  
Disease Severity ◽  
Bowel Disease ◽  
Severe Disease ◽  
Academic Medical Center ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Test Order ◽  
Inflammatory Bowel

Abstract Background Guidelines recommend testing inflammatory bowel disease (IBD) patients hospitalized with flare for Clostridioides difficile infection (CDI), though little is known about whether a delay in testing for CDI is related to adverse outcomes. We examined the relationship between time-to-C. difficile PCR test order, collection, and result with adverse IBD outcomes. Methods We performed a retrospective cohort study of IBD patients hospitalized with flare through the emergency department (ED) between 2013 and 2020 at an urban academic medical center. The time from ED presentation to C. difficile test order (time-to-order), sample collection (time-to-collection), and test result (time-to-result) were collected. Time-to-result was stratified by within 6 hours, 6–24 hours, and 24 hours or longer. The primary outcome was length of stay (LOS). Secondary outcomes were inpatient anti-TNF administration and surgery. We used hemodynamic and laboratory values at presentation to evaluate disease severity as a confounding variable between length of stay and time-dependent variables. Results We identified 122 IBD patients hospitalized with flare. There were no significant differences in baseline characteristics among time-to-result groups. Despite a shorter time-to-result, the average LOS in the 6 hours group was 7.3 days, longer compared to the 6–24 hours group (4.3 days, p=0.018) and the 24 hours group (4.2 days, p=0.035; Table 1). There were no differences in inpatient anti-TNF administration (p=0.10) or surgery (p=0.08) among time-to-result groups. The markers of disease severity that correlated with longer LOS were C-reactive protein (CRP) (0.28 days, p=0.003), heart rate (0.478 days, p&lt;0.001), diastolic hypotension (0.228 days, p=0.01), and hypoalbuminemia (0.215 days, p=0.02). Higher CRP correlated with earlier time-to-result (-0.218 hours, p=0.02). Patients with more markers of disease severity had earlier times-to-result (12.8 hours vs. 32.2 hours, p=0.014) and had a longer LOS (7.9 vs. 3.4 days, p=0.007) (Table 2). Patients with more severe disease had an earlier time-to-order (4.48 hours) compared to those with less severe disease (17.4 hours), though this difference did not meet statistical significance (p=0.09; Table 2). Conclusion Earlier time-to-result for CDI is associated with longer LOS in IBD patients hospitalized with flare. This inverse relationship is confounded by disease severity at presentation: patients with more severe disease have a shorter time-to-result and a longer LOS. It may be that these patients produce a stool sample more readily; however, the near significance of differences in time-to-order among severity groups suggest a role for provider bias, which must be studied further. Delay in testing was not associated with higher rates of inpatient anti-TNF administration or surgery.

scholarly journals Risk factors for developing high-output ileostomy: a retrospective study

2020 ◽  
Author(s):  
Xiao Jian'an ◽  
Dongxiao Bai ◽  
Lei Li ◽  
Zhiling Shen ◽  
Tianchen Huang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Colorectal Cancer ◽  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Total Colectomy ◽  
Neoadjuvant Chemoradiotherapy ◽  
Clear Correlation ◽  
Abdominal Infection ◽  
Inflammatory Bowel

Abstract Background: Prophylactic ileostomy and colostomy have been widely used to reduce the risk and complications of anastomotic leakage with high-risk colorectal cancer after operation. However, prophylactic ileostomy itself has some complications, and ileostomy high out-put syndrome is one of them. This study was performed to explore the risk factors of HOS in ileostomy.Methods: A total of 114 patients with HOS were screened out from 494 eligible ileostomy patients in the last five years. The clinical and pathological data were analyzed. The relationship between HOS and clinicopathological data was analyzed. Multivariate analysis was performed by logistic regression.Results: There was no clear correlation between the occurrence of HOS with sex, age, gross typing, histological grade, location of tumors, lymph node metastasis and TNM stage (p > 0.05). Preoperative complications including inflammatory bowel disease, diabetes mellitus and neoadjuvant chemoradiotherapy were risk factors for HOS (p < 0.05). Total colectomy and abdominal infection were risk factors for HOS (p < 0.05) during operation.Conclusion: Inflammatory bowel disease, diabetes mellitus and neoadjuvant radiotherapy and chemotherapy in patients with colorectal cancer are the preoperative risk factors for HOS. Total colectomy and postoperative abdominal infection are the postoperative risk factors for HOS.

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