scholarly journals Antibiotics for Treatment of Clostridium difficile Infection in Hospitalized Patients with Inflammatory Bowel Disease

2014 ◽  
Vol 58 (9) ◽  
pp. 5054-5059 ◽  
Author(s):  
Henry A. Horton ◽  
Seper Dezfoli ◽  
Dror Berel ◽  
Julianna Hirsch ◽  
Andrew Ippoliti ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Clostridium Difficile ◽  
Length Of Stay ◽  
Bowel Disease ◽  
Standard Of Care ◽  
Inclusion Criteria ◽  
Content Type ◽  
Lengths Of Stay ◽  
Inflammatory Bowel

ABSTRACTPatients with inflammatory bowel disease (IBD), namely ulcerative colitis (UC) and Crohn's disease (CD), have worse outcomes withClostridium difficileinfection (CDI), including increased readmissions, colectomy, and death. Oral vancomycin is recommended for the treatment of severe CDI, while metronidazole is the standard of care for nonsevere infection. We aimed to assess treatment outcomes of CDI in IBD. We conducted a retrospective observational study of inpatients with CDI and IBD from January 2006 through December 2010. CDI severity was assessed using published criteria. Outcomes included readmission for CDI within 30 days and 12 weeks, length of stay, colectomy, and death. A total of 114 patients met inclusion criteria (UC, 62; CD, 52). Thirty-day readmissions were more common among UC than CD patients (24.2% versus 9.6%;P= 0.04). Same-admission colectomy occurred in 27.4% of UC patients and 0% of CD patients (P< 0.01). Severe CDI was more common among UC than CD patients (32.2% versus 19.4%;P= 0.12) but not statistically significant. Two patients died from CDI-associated complications (UC, 1; CD, 1). Patients with UC and nonsevere CDI had fewer readmissions and shorter lengths of stay when treated with a vancomycin-containing regimen compared to those treated with metronidazole (30-day readmissions, 31.0% versus 0% [P= 0.04]; length of stay, 13.62 days versus 6.38 days [P= 0.02]). Patients with UC and nonsevere CDI have fewer readmissions and shorter lengths of stay when treated with a vancomycin-containing regimen relative to those treated with metronidazole alone. Patients with ulcerative colitis and CDI should be treated with vancomycin.

scholarly journals P210 Clostridium difficile infection in pre-existing inflammatory bowel disease: Management and outcomes

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S244-S245
Author(s):  
I CAMPBELL ◽  
E Brownson ◽  
E Robertson
Keyword(s):  
Inflammatory Bowel Disease ◽  
Clostridium Difficile ◽  
Length Of Stay ◽  
Clostridium Difficile Infection ◽  
Bowel Disease ◽  
Surgical Intervention ◽  
Morbidity And Mortality ◽  
Health Board ◽  
Inflammatory Bowel ◽  
One Year

Abstract Background Inflammatory bowel disease (IBD) is a recognised risk factor for clostridium difficile infection (CDI), and CDI in an IBD patient is associated with higher morbidity and mortality. It is thought that factors including alterations in the gut microbiome, mucosal disruption and immunosuppression provide a synergistic environment for CDI to complicate an IBD flare. Despite this, there is conflicting evidence available on management. Our aim was to examine a series of recent cases to assess our own practice and subsequent outcomes. Methods A retrospective analysis was carried out of hospitalised cases of CDI in IBD patients in Greater Glasgow and Clyde from 2017 to 2018. Patients were identified via the CDI database held by the microbiology department; those with co-existing IBD were extrapolated. Data collected included demographics, IBD subtype and presence of other CDI risk factors. Severity of symptoms was assessed using Truelove and Witts Criteria. Initial management and changes following the diagnosis of CDI were noted. Outcomes were measured by the length of stay, survival to discharge, and requirement for surgical intervention. One year outcomes were assessed by recording mortality, treatment escalation and re-admission to hospital. Results 29 patients in total were identified (61% female, 39% male). Twenty-one had a diagnosis of ulcerative colitis, 7 Crohn’s disease, and 1 IBD unclassified. Twenty-four were on immunosuppressive therapy at the time of CDI, 11 were on dual or triple immunosuppression. This was continued during admission in all but three cases. Once the diagnosis of CDI was established, metronidazole was given in 16 cases and vancomycin in 13. Steroid treatment varied - 13 received oral steroids, 5 IV steroids and 11 no steroids. There was no clear correlation between steroid management and outcome. Assessment with the Travis criteria on day 3 indicated a high chance of colectomy in 12 patients, however only one required surgical intervention. No patients received a faecal transplant. The median length of stay was 15 days (range 3–169). One patient did not survive to discharge. In those surviving to discharge, a further 6 had died at one year, bringing the one-year mortality to 24%. Three had CDI as a contributory factor listed on the death certificate. 31% of surviving patients had their IBD treatment escalated in the year following admission, 17% were treated for CDI relapse, and 28% had readmission to hospital. Conclusion Managing CDI in patients with co-existing IBD is challenging. This case series highlights the lack of consensus on how this should be approached, even within a single health board. Morbidity and mortality are high. This suggests that a wider body of work is required to establish guidelines and provide better outcomes.

scholarly journals Very Early-Onset Inflammatory Bowel Disease (VEO-IBD) Presenting with Recurrent Leukocytoclastic Vasculitis Preceded by Streptococcal Pharyngitis

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Ashley Fonseca ◽  
Julee Sunny ◽  
Lina M. Felipez
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Clostridium Difficile ◽  
Bowel Disease ◽  
Early Onset ◽  
Leukocytoclastic Vasculitis ◽  
Streptococcal Pharyngitis ◽  
Clostridium Difficile Toxin ◽  
Inflammatory Bowel ◽  
Multiple Episodes

Inflammatory bowel disease (IBD) that presents in children <6 years of age is known as very early-onset IBD (VEO-IBD). Extraintestinal manifestations in IBD, such as erythema nodosum (EN), pyoderma gangrenosum (PG), and, less likely, leukocytoclastic vasculitis (LV), are more commonly present in Crohn’s disease. Association between LV and ulcerative colitis (UC) is not commonly seen. We report a case of a 6-year-old female with a VEO-IBD UC phenotype presenting with multiple episodes of leukocytoclastic vasculitis, each preceded by streptococcal pharyngitis. Prior to the diagnosis of VEO-IBD, a skin biopsy was obtained and had shown leukocytoclastic vasculitis with a negative IgA stain. Initial laboratory results were remarkable for leukocytosis and increased anti-strep O and anti-DNase B titers. Gastrointestinal panel PCR demonstrated Clostridium difficile toxin A/B. Treatment for LV consisted of methylprednisolone IV 20 mg for four days with a weaning schedule of prednisolone for two weeks and naproxen 250 mg BID for three days. Clostridium difficile was treated with metronidazole 250 mg TID for ten days. She remained stable for three years until she presented with continuous bloody stools, newly onset chest pain, and shortness of breath. Computed tomography angiogram (CTA) was normal. Stool calprotectin was elevated at 658 mcg/gm. Abdominal magnetic resonance enterography (MRE), esophagogastroduodenoscopy, and colonoscopy confirmed a VEO-IBD ulcerative colitis phenotype. She was started on infliximab 10 mg/kg every four weeks after infliximab titers, and antibodies were obtained. Currently, the patient remains on clinical and biochemical remission, with no recent LV episodes or recurrence of streptococcal pharyngitis. Our patient is unique as no case report has been published with multiple episodes of leukocytoclastic vasculitis in association with a VEO-IBD UC phenotype.

Prebiotics and Probiotics in Inflammatory Bowel Disease: Where are we now and where are we going?

2020 ◽  
Vol 15 (3) ◽  
pp. 216-233 ◽  
Author(s):  
Maliha Naseer ◽  
Shiva Poola ◽  
Syed Ali ◽  
Sami Samiullah ◽  
Veysel Tahan
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Clinical Trials ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Adverse Effects ◽  
Bowel Disease ◽  
Relapse Prevention ◽  
Remission Induction ◽  
Inflammatory Bowel

The incidence, prevalence, and cost of care associated with diagnosis and management of inflammatory bowel disease are on the rise. The role of gut microbiota in the causation of Crohn's disease and ulcerative colitis has not been established yet. Nevertheless, several animal models and human studies point towards the association. Targeting intestinal dysbiosis for remission induction, maintenance, and relapse prevention is an attractive treatment approach with minimal adverse effects. However, the data is still conflicting. The purpose of this article is to provide the most comprehensive and updated review on the utility of prebiotics and probiotics in the management of active Crohn’s disease and ulcerative colitis/pouchitis and their role in the remission induction, maintenance, and relapse prevention. A thorough literature review was performed on PubMed, Ovid Medline, and EMBASE using the terms “prebiotics AND ulcerative colitis”, “probiotics AND ulcerative colitis”, “prebiotics AND Crohn's disease”, “probiotics AND Crohn's disease”, “probiotics AND acute pouchitis”, “probiotics AND chronic pouchitis” and “prebiotics AND pouchitis”. Observational studies and clinical trials conducted on humans and published in the English language were included. A total of 71 clinical trials evaluating the utility of prebiotics and probiotics in the management of inflammatory bowel disease were reviewed and the findings were summarized. Most of these studies on probiotics evaluated lactobacillus, De Simone Formulation or Escherichia coli Nissle 1917 and there is some evidence supporting these agents for induction and maintenance of remission in ulcerative colitis and prevention of pouchitis relapse with minimal adverse effects. The efficacy of prebiotics such as fructooligosaccharides and Plantago ovata seeds in ulcerative colitis are inconclusive and the data regarding the utility of prebiotics in pouchitis is limited. The results of the clinical trials for remission induction and maintenance in active Crohn's disease or post-operative relapse with probiotics and prebiotics are inadequate and not very convincing. Prebiotics and probiotics are safe, effective and have great therapeutic potential. However, better designed clinical trials in the multicenter setting with a large sample and long duration of intervention are needed to identify the specific strain or combination of probiotics and prebiotics which will be more beneficial and effective in patients with inflammatory bowel disease.

Clostridium Difficile Infection in Inflammatory Bowel Disease Patients

2019 ◽  
Vol 19 (7) ◽  
pp. 929-935
Author(s):  
Abdulmajeed A. Albarrak ◽  
Bhupinder S. Romana ◽  
Suleyman Uraz ◽  
Mohamad H. Yousef ◽  
Alhareth A. Juboori ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Bowel Disease ◽  
Health Care Organizations ◽  
Fecal Microbiota ◽  
Fecal Microbiota Transplant ◽  
Expert Review ◽  
Inflammatory Bowel ◽  
High Index Of Suspicion

Background:The rising incidence of Clostridium difficile infection (CDI) in the general population has been recognized by health care organizations worldwide. The emergence of hypervirulent strains has made CDI more challenging to understand and treat. Inflammatory bowel disease (IBD) patients are at higher risk of infection, including CDI.Objective:A diagnostic approach for recurrent CDI has yet to be validated, particularly for IBD patients. Enzyme immunoassay (EIA) for toxins A and B, as well as glutamate dehydrogenase EIA, are both rapid testing options for the identification of CDI. Without a high index of suspicion, it is challenging to initially differentiate CDI from an IBD flare based on clinical evaluation alone.Methods:Here, we provide an up-to-date review on CDI in IBD patients. When caring for an IBD patient with suspected CDI, it is appropriate to empirically treat the presumed infection while awaiting further test results.Results:Treatment with vancomycin or fidaxomicin, but not oral metronidazole, has been advocated by an expert review from the clinical practice update committee of the American Gastroenterology Association. Recurrent CDI is more common in IBD patients compared to non-IBD patients (32% versus 24%), thus more aggressive treatment is recommended for IBD patients along with early consideration of fecal microbiota transplant.Conclusion:Although the use of infliximab during CDI has been debated, clinical experience exists supporting its use in an IBD flare, even with active CDI when needed.

scholarly journals The Changing Prognosis of Ulcerative Colitis and Crohn’s Disease by Decades

2021 ◽  
Author(s):  
Burton I Korelitz ◽  
Judy Schneider
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Medical Therapy ◽  
Bowel Disease ◽  
Surgical Intervention ◽  
Inflammatory Bowel

Abstract We present a bird’s eye view of the prognosis for both ulcerative colitis and Crohn’s disease as contained in the database of an Inflammatory Bowel Disease gastroenterologist covering the period from 1950 until the present utilizing the variables of medical therapy, surgical intervention, complications and deaths by decades.

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