INCIDENCE AND RISK FACTORS OF CLOSTRIDIUM DIFFICILE IN-FECTION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Authors

  • Oana STOICA University of Medicine and Pharmacy”Grigore T. Popa”- Iasi
  • Anca TRIFAN University of Medicine and Pharmacy”Grigore T. Popa”- Iasi
  • Camelia COJOCARU University of Medicine and Pharmacy”Grigore T. Popa”- Iasi
  • Irina GIRLEANU University of Medicine and Pharmacy”Grigore T. Popa”- Iasi
  • Roxana MAXIM University of Medicine and Pharmacy”Grigore T. Popa”- Iasi
  • C. STANCIU University of Medicine and Pharmacy”Grigore T. Popa”- Iasi

Abstract

Recent changes in the epidemiology of Clostridium difficile infection (CDI) include the identification of patients with inflammatory bowel disease (IBD) as a group at risk in comparison to the general population. Aim: To identify the incidence and risk factors for CDI among patients with IBD. Material and methods: Case-control study of 78 patients diagnosed with IBD, hospitalized at the Iasi Institute of Gastroenterology and Hepatology between January 2012 and -July 2014. Demographic data and clinical characteristics were reviewed for all patients. IBD patients with positive C. difficile toxins A and B tests were matched by sex, age and type of IBD with IBD patients hospitalized in the same period with negative C. difficile toxins tests. Results: Both groups were comparable for baseline characteristics. Of the 78 patients diagnosed with IBD included in the study, C. difficile was detected in 26 patients (33.33%). There was no statistical difference regarding length of hospital stay (10.42±7.34 vs. 8.01±6.14 days, p=0.129) between the two study groups. Risk factors for CDI in patients with IBD were: ulcerative colitis (OR=1.90, CI= 1.320-2.720, p=0.001), use of proton pump inhibitors (OR=1.57, CI=1.133-2.032, p=0.012), previous antibiotic use (OR=2.3, CI=1.587-3.332, p<0.0001), and albumin<3g/dl (OR=1.78, CI=1.023-5.558, p=0.038). Immunosuppressive and anti TNF-α treatment were not risk factors for C. difficile development in patients with IBD. Conclusions: CDI in patients with IBD is a serious infection and should be treated aggressively with close clinical follow-up. Ulcerative colitis, previous treatment with antibiotics and proton pump inhibitors represent risk factors for CDI development in patients with IBD.

Author Biographies

  • Oana STOICA, University of Medicine and Pharmacy”Grigore T. Popa”- Iasi

    Faculty of Medicine
    Department of Medical Specialties (I)
    Institute of Gastroenterology and Hepatology

  • Anca TRIFAN, University of Medicine and Pharmacy”Grigore T. Popa”- Iasi

    Faculty of Medicine
    Department of Medical Specialties (I)
    Institute of Gastroenterology and Hepatology

  • Camelia COJOCARU, University of Medicine and Pharmacy”Grigore T. Popa”- Iasi

    Faculty of Medicine
    Department of Medical Specialties (I)
    Institute of Gastroenterology and Hepatology

  • Irina GIRLEANU, University of Medicine and Pharmacy”Grigore T. Popa”- Iasi

    Faculty of Medicine
    Department of Medical Specialties (I)
    Institute of Gastroenterology and Hepatology

  • Roxana MAXIM, University of Medicine and Pharmacy”Grigore T. Popa”- Iasi

    Faculty of Medicine
    Department of Medical Specialties (I)
    Institute of Gastroenterology and Hepatology

  • C. STANCIU, University of Medicine and Pharmacy”Grigore T. Popa”- Iasi

    Faculty of Medicine
    Department of Medical Specialties (I)
    Institute of Gastroenterology and Hepatology

References

1. Khanna S, Pardi DS. The growing incidence and severity of Clostridium difficile infection in inpatient and outpatient settings. Expert Rev Gastroenterol Hepatol. 2010; 4: 409-416.
2. Miron L, Filimon R, Petrariu FD, Matei MC. Clostridium difficile epidemic outbreak in an oncology unit. Rev Med Chir Soc Med Nat. 2014; 118(1): 165-170.
3. Bartlett JG, Gerding DN. Clinical recognition and diagnosis of Clostridium difficile infection. Clin Infect Dis. 2008; 46(Suppl.1): S12-S18.
4. Ananthakrishnan AN. Clostridium difficile infection: epidemiology, risk factors and management. Nat Rev Gastroenterol Hepatol. 2011; 8: 17–26.
5. Issa M, Vijayapal A, Graham MB, et al. Impact of Clostridium difficile on inflammatory bowel disease. Clin Gastroenterol Hepatol. 2007; 5: 345–351.
6. Rodemann JF, Dubberke ER, Reske KA, Seo da H, Stone CD. Incidence of Clostridium difficile infection in inflammatory bowel disease. Clin Gastroenterol Hepatol. 2007; 5: 339–344.
7. Ananthakrishnan AN, McGinley EL, Binion DG. Excess hospitalization burden associated with Clos-tridium difficile in patients with inflammatory bowel disease. Gut. 2008; 57: 205–210.
8. Bossuyt P, Verhaegen J, Van Assche G, Rutgeerts P, Vermeire S. Increasing incidence of Clostridium difficile-associated diarrhea in inflammatory bowel disease. J Crohns Colitis. 2009; 3: 4-7.
9. Jen MH, Saxena S, Bottle A, Aylin P, Pollok RC. Increased health burden associated with Clostridium difficile diarrhoea in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2011;33:1322–1331.
10. Ananthakrishnan AN, McGinley EL, Saeian K, Binion DG. Temporal trends in disease outcomes related to Clostridium difficile infection in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2011; 17: 976-983.
11. Jodorkovsky D, Young Y, Abreu MT. Clinical outcomes of patients with ulcerative colitis and co-existing Clostridium difficile infection. Dig Dis Sci. 2010; 55: 415–420.
12. Murthy S K, Steinhart AH, Tinmouth J, Austin PC, Daneman N, Nguyen GC. Impact of Clostridium difficile colitis on 5-year health outcomes in patients with ulcerative colitis. Aliment Pharmacol Ther. 2012; 36(11): 1032-1039.
13. Trifan A, Stanciu C, Stoica O, Girleanu I, Cojocariu C. Impact of Clostridium difficile infection on inflammatory bowel disease outcome: A review. World J Gastroenterol. 2014; 20(33): 11736-11742.
14. Ricciardi J O, Ogilvie W Jr., Roberts P L, Marcello P W, Concannon T W, Baxter N N. Epidemiology of Clostridium difficile colitis in hospitalized patients with inflammatory bowel disease. Dis Col Rect. 2009; 52(1): 40-45.
15. Nguyen GC, Kaplan GG, Harris ML, Brant SR. A national survey of the prevalence and impact of Clostridium difficile infection among hospitalized inflammatory bowel disease patients. Am J Gastro-enterol 2008; 103: 1443-1450.
16. Ananthakrishnan AN, Binion DG. Impact of Clostridium difficile on inflammatory bowel disease. Expert Rev Gastroenterol Hepatol. 2010; 4(5): 589-600.

Additional Files

Published

2015-03-31

Issue

Vol. 119 No. 1 (2015): The Medical-Surgical Journal

Section

INTERNAL MEDICINE - PEDIATRICS

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