scholarly journals The interplay of Clostridioides difficile infection and inflammatory bowel disease

2021 ◽  
Vol 14 ◽  
pp. 175628482110202
Author(s):  
Kanika Sehgal ◽  
Devvrat Yadav ◽  
Sahil Khanna
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Adverse Outcomes ◽  
Molecular Tests ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Clostridioides Difficile Infection ◽  
Pros And Cons ◽  
Inflammatory Bowel ◽  
High Index Of Suspicion

Inflammatory bowel disease (IBD) is a chronic disease of the intestinal tract that commonly presents with diarrhea. Clostridioides difficile infection (CDI) is one of the most common complications associated with IBD that lead to flare-ups of underlying IBD. The pathophysiology of CDI includes perturbations of the gut microbiota, which makes IBD a risk factor due to the gut microbial alterations that occur in IBD, predisposing patients CDI even in the absence of antibiotics. Superimposed CDI not only worsens IBD symptoms but also leads to adverse outcomes, including treatment failure and an increased risk of hospitalization, surgery, and mortality. Due to the overlapping symptoms and concerns with false-positive molecular tests for CDI, diagnosing CDI in patients with IBD remains a clinical challenge. It is crucial to have a high index of suspicion for CDI in patients who seem to be experiencing an exacerbation of IBD symptoms. Vancomycin and fidaxomicin are the first-line treatments for the management of CDI in IBD. Microbiota restoration therapies effectively prevent recurrent CDI in IBD patients. Immunosuppression for IBD in IBD patients with CDI should be managed individually, based on a thorough clinical assessment and after weighing the pros and cons of escalation of therapy. This review summarizes the epidemiology, pathophysiology, the diagnosis of CDI in IBD, and outlines the principles of management of both CDI and IBD in IBD patients with CDI.

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.

Anti-TNF containing regimens may be associated with increased risk of Clostridioides difficile infection in patients with underlying inflammatory bowel disease

2020 ◽  
Vol 68 (3) ◽  
pp. 125-130 ◽  
Author(s):  
Fahimeh Sadat Gholam-Mostafaei ◽  
Abbas Yadegar ◽  
Hamid Asadzadeh Aghdaei ◽  
Masoumeh Azimirad ◽  
Nasser Ebrahimi Daryani ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Clostridioides Difficile Infection ◽  
Inflammatory Bowel

scholarly journals A68 CLOSTRIDIOIDES DIFFICILE INFECTION IN CHILDREN WITH INFLAMMATORY BOWEL DISEASE

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 82-82
Author(s):  
H Zohni ◽  
A Chandrakumar ◽  
W El-Matary
Keyword(s):  
Inflammatory Bowel Disease ◽  
Incidence Rate ◽  
Bowel Disease ◽  
Cox Regression ◽  
Categorical Variables ◽  
Mortality And Morbidity ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Clostridioides Difficile Infection ◽  
Inflammatory Bowel

Abstract Background Toxigenic Clostridioides difficile (C. difficile), previously known as Clostridium difficile, is an anaerobic gram-positive spore-forming opportunistic pathogen associated with profuse diarrhea and gastroenteritis associated mortality and morbidity especially in patients with inflammatory bowel disease (IBD). Aims To investigate the incidence and risk factors associated with clostridioides difficile infection (CDI) in children with IBD in the province of Manitoba. Methods Our longitudinal population-based cohort comprised of all children and young adults < 17y diagnosed with IBD in the Canadian province of Manitoba between 2011 and 2019. The diagnosis of CDI was confirmed based on the Triage C. difficile immunoassay and polymerase chain reaction assay to detect the presence of toxigenic C. difficile. Fisher’s exact test was used to examine the relationship between categorical variables. Cox-regression model was used to estimate the risk of CDI development in IBD patients. Results Among the 261 children with IBD, 20 (7.7%) developed CDI with an incidence rate of 5.04 cases per 1000 person-years and the median age at diagnosis of 12.96 years (IQR: 9.33–15.81). The incidence rate of CDI among UC and CD patients were 4.16 cases per 1000 person-years and 5.88 cases per 1000 person-years, respectively (p=0.46). Compared to children without CDI, those who had CDI were at increased risk of future exposure to systemic corticosteroids (hazard ratio (HR)=4.30; 95% CI: 1.44–12.87) and anti-tumor necrosis factor (TNF) biologics (HR=3.37; 95% CI: 1.13–10.09). Recurrence rate of CDI in our pediatric IBD population was 25%. Conclusions Our findings confirm that children with IBD are at a high risk of developing CDI, which may predict future escalation of IBD therapy. Funding Agencies The Children’s Hospital Research Institute of Manitoba

scholarly journals P777 Clostridioides difficile infection in children with inflammatory bowel disease: A Canadian population-based study

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S616-S616
Author(s):  
W El-Matary ◽  
A Chandrakumar ◽  
H Zohni
Keyword(s):  
Inflammatory Bowel Disease ◽  
Incidence Rate ◽  
Bowel Disease ◽  
Cox Regression ◽  
Population Based ◽  
Categorical Variables ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Clostridioides Difficile Infection ◽  
Inflammatory Bowel

Abstract Background Toxigenic Clostridioides difficile (C. difficile), previously known as Clostridium difficile, is an anaerobic gram-positive spore-forming opportunistic pathogen associated with profuse diarrhoea and gastroenteritis associated mortality, especially in children with inflammatory bowel disease (IBD). The aim of this work was to investigate the incidence and risk factors associated with Clostridioides difficile infection (CDI) in children with IBD in the province of Manitoba, Canada. Methods Our longitudinal population-based cohort comprised of all children and young adults <17 years diagnosed with IBD in the Canadian province of Manitoba between 2011 and 2019. The diagnosis of CDI was confirmed based on the Triage C. difficile immunoassay and polymerase chain reaction assay to detect the presence of toxigenic C. difficile. Fisher’s exact test was used to examine the relationship between categorical variables. Cox-regression model was used to estimate the risk of CDI development in IBD patients. Results Among the 261 children with IBD, 20 (7.7%) developed CDI with an incidence rate of 5.04 cases per 1000 person-years and the median age at diagnosis of 12.96 years (IQR: 9.33–15.81). The incidence rate of CDI among UC and CD patients were 4.16 cases per 1000 person-years and 5.88 cases per 1000 person-years, respectively (p = 0.46). Compared to children without CDI, those who had CDI were at increased risk of future exposure to systemic corticosteroids (hazard ratio (HR) = 4.30; 95% CI: 1.44–12.87) and anti-tumour necrosis factor (TNF) biologics (HR = 3.37; 95% CI: 1.13–10.09). Recurrence rate of CDI in our paediatric IBD population was 25%. Conclusion Our findings confirm that children with IBD are at a high risk of developing CDI, which may predict future escalation of IBD therapy.

Clostridioides difficile Infection in Children With Inflammatory Bowel Disease

2019 ◽  
Vol 26 (11) ◽  
pp. 1700-1706
Author(s):  
Abin Chandrakumar ◽  
Hussein Zohni ◽  
Wael El-Matary
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Cox Regression ◽  
Population Based ◽  
Incidence Rates ◽  
Categorical Variables ◽  
Fisher Exact Test ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background The study’s objective was to investigate the incidence and risk factors associated with Clostridioides difficile (previously known as Clostridium) infection (CDI) in children with inflammatory bowel disease (IBD) in the province of Manitoba. Methods Our longitudinal population-based cohort was comprised of all children and young adults aged <17 years diagnosed with IBD in the Canadian province of Manitoba between 2011 and 2019. The diagnosis of CDI was confirmed based on the Triage C. difficile immunoassay and polymerase chain reaction assay to detect the presence of toxigenic C. difficile. The Fisher exact test was used to examine the relationship between categorical variables. A Cox regression model was used to estimate the risk of CDI development in IBD patients. Results Among 261 children with IBD, 20 (7.7%) developed CDI with an incidence rate of 5.04 cases per 1000 person-years, and the median age at diagnosis (interquartile range) was 12.96 (9.33–15.81) years. The incidence rates of CDI among UC and CD patients were 4.16 cases per 1000 person-years and 5.88 cases per 1000 person-years, respectively (P = 0.46). Compared with children without CDI, those who had CDI were at increased risk of future exposure to systemic corticosteroids (adjusted hazard ratio [aHR], 4.38; 95% confidence interval [CI], 1.46–13.10) and anti–tumor necrosis factor (anti-TNF) biologics (aHR, 3.31; 95% CI, 1.11–9.90). The recurrence rate of CDI in our pediatric IBD population was 25%. Conclusions Our findings confirm that children with IBD are at high risk of developing CDI, which may predict future escalation of IBD therapy.

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