Clostridium difficile in Inflammatory Bowel Disease: A Retrospective Study

William Gillespie; Neil Marya; Julien Fahed; Gregory Leslie; Krunal Patel; David R Cave

doi:10.1155/2017/4803262

Clostridium difficile in Inflammatory Bowel Disease: A Retrospective Study

Gastroenterol Res Pract. 2017:2017:4803262. doi: 10.1155/2017/4803262. Epub 2017 Oct 4.

Authors

William Gillespie¹, Neil Marya², Julien Fahed³, Gregory Leslie⁴, Krunal Patel⁵, David R Cave⁵

Affiliations

¹ Department of Medicine, University of Massachusetts School of Medicine, 55 Lake Avenue North, Worcester, MA 01604, USA.
² Department of Gastroenterology, University of California Los Angeles, Los Angeles, CA, USA.
³ Department of Gastroenterology, Aurora Healthcare, Milwaukee, WI, USA.
⁴ Department of Medicine, University of Massachusetts, Worcester, MA, USA.
⁵ Department of Gastroenterology, University of Massachusetts, Worcester, MA, USA.

Abstract

Aim: To investigate the epidemiology and risk factors of Clostridium difficile infections (CDI) in patients with inflammatory bowel disease (IBD).

Methods: This is a retrospective study of patients diagnosed with IBD. 1006 charts were screened and 654 patients met the inclusion criteria. Patients were divided into 2 cohorts based on the presence of prior diagnosis of CDI. Statistical analysis with Pearson's chi-squared and two-sample t-test was performed.

Results: The incidence of CDI among IBD patients was 6.7%. There was equal prevalence of CDI among Crohn's disease (CD) (n = 21, 49%) and ulcerative colitis (UC) (n = 22, 51%). IBD patients acquired CDI at a mean age of 42.7 years, with 56% of infections acquired in the community and only 28% associated with healthcare. Only 30% of IBD patients with CDI had prior antibiotic use, and 16% had prior steroid use. IBD patients were significantly more likely to require biologic therapy (57% versus 37%, p < 0.01) and have extraintestinal manifestations of IBD (43% versus 28%, p < 0.02).

Conclusions: IBD patients are more susceptible to CDI at a younger age and often lack traditional risk factors. IBD patients with at least one CDI were more likely to require biologic therapy and had greater rates of extraintestinal manifestations.