Roshan Razik1,2,3, Amir Rumman4, Zoya Bahreini4, Allison McGeer5, Geoffrey C Nguyen1. 1. Department of Medicine, Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada. 2. Division of Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 3. Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA. 4. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 5. Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada.
Abstract
OBJECTIVES: Recurrent Clostridium difficile infection (rCDI) contributes to a significant burden of disease in patients with inflammatory bowel disease (IBD). In this study, we seek to identify risk factors for rCDI in a population of IBD patients at the Mount Sinai Hospital IBD Centre. METHODS: In this retrospective cohort study, IBD patients with rCDI diagnosed between 2010 and 2013 were identified and compared with IBD patients with single-episode CDI. Multivariate regression was used to identify predictors of rCDI in IBD. Outcome analysis was performed for hospitalizations due to CDI, colectomy, and CDI-attributable mortality. RESULTS: A total of 503 patients were included, 110 (22%) of whom had IBD (49% CD, 51% ulcerative colitis). Recurrent CDI occurred in 32% of IBD patients compared with 24% of non-IBD patients (P<0.01). IBD patients with rCDI were more likely than those without rCDI to report recent antibiotic therapy (42.9 vs. 30.7%, P<0.01), 5-aminosalicylic acid (5-ASA) use (51.5 vs. 30.7%, P<0.001), steroid use (51.4 vs. 33.3%, P<0.001), and biologic therapy (48.6 vs. 40.0%, P<0.01). Infliximab (34.3 vs. 17.3%, P<0.01) but not adalimumab was associated with more rCDI events. Using a Cox model of predictors of rCDI in IBD, significant predictors included non-ileal Crohn's disease (hazard ratio (HR) 2.85, 95% confidence interval (CI) 1.30-6.30) and the use of 5-ASA (HR 2.15, 95% CI 1.11-4.18). CONCLUSIONS: Compared with the general population, IBD patients are 33% more likely to experience rCDI. Within the IBD cohort, exposure to certain drug classes (antibiotics, 5-ASA, steroids, certain biologics) and non-ileal Crohn's disease were found to be the predictors of rCDI.
OBJECTIVES: Recurrent Clostridium difficileinfection (rCDI) contributes to a significant burden of disease in patients with inflammatory bowel disease (IBD). In this study, we seek to identify risk factors for rCDI in a population of IBD patients at the Mount Sinai Hospital IBD Centre. METHODS: In this retrospective cohort study, IBD patients with rCDI diagnosed between 2010 and 2013 were identified and compared with IBD patients with single-episode CDI. Multivariate regression was used to identify predictors of rCDI in IBD. Outcome analysis was performed for hospitalizations due to CDI, colectomy, and CDI-attributable mortality. RESULTS: A total of 503 patients were included, 110 (22%) of whom had IBD (49% CD, 51% ulcerative colitis). Recurrent CDI occurred in 32% of IBD patients compared with 24% of non-IBD patients (P<0.01). IBD patients with rCDI were more likely than those without rCDI to report recent antibiotic therapy (42.9 vs. 30.7%, P<0.01), 5-aminosalicylic acid (5-ASA) use (51.5 vs. 30.7%, P<0.001), steroid use (51.4 vs. 33.3%, P<0.001), and biologic therapy (48.6 vs. 40.0%, P<0.01). Infliximab (34.3 vs. 17.3%, P<0.01) but not adalimumab was associated with more rCDI events. Using a Cox model of predictors of rCDI in IBD, significant predictors included non-ileal Crohn's disease (hazard ratio (HR) 2.85, 95% confidence interval (CI) 1.30-6.30) and the use of 5-ASA (HR 2.15, 95% CI 1.11-4.18). CONCLUSIONS: Compared with the general population, IBD patients are 33% more likely to experience rCDI. Within the IBD cohort, exposure to certain drug classes (antibiotics, 5-ASA, steroids, certain biologics) and non-ileal Crohn's disease were found to be the predictors of rCDI.
Authors: Mary Y Hu; Kianoosh Katchar; Lorraine Kyne; Seema Maroo; Sanjeev Tummala; Valley Dreisbach; Hua Xu; Daniel A Leffler; Ciarán P Kelly Journal: Gastroenterology Date: 2008-12-13 Impact factor: 22.682
Authors: Abhishek Deshpande; Vinay Pasupuleti; Priyaleela Thota; Chaitanya Pant; David D K Rolston; Adrian V Hernandez; Curtis J Donskey; Thomas G Fraser Journal: Infect Control Hosp Epidemiol Date: 2015-01-28 Impact factor: 3.254
Authors: Ralph B D'Agostino; Sylva H Collins; Karol M Pencina; Yin Kean; Sherwood Gorbach Journal: Clin Infect Dis Date: 2014-03-05 Impact factor: 9.079
Authors: Alyce Anderson; Benjamin Click; Claudia Ramos-Rivers; Debbie Cheng; Dmitriy Babichenko; Ioannis E Koutroubakis; Jana G Hashash; Marc Schwartz; Jason Swoger; Arthur M Barrie; Michael A Dunn; Miguel Regueiro; David G Binion Journal: Inflamm Bowel Dis Date: 2017-12 Impact factor: 5.325
Authors: Robert P Hirten; Ari Grinspan; Shih-Chen Fu; Yuying Luo; Mayte Suarez-Farinas; John Rowland; Eduardo J Contijoch; Ilaria Mogno; Nancy Yang; Tramy Luong; Philippe R Labrias; Inga Peter; Judy H Cho; Bruce E Sands; Jean Frederic Colombel; Jeremiah J Faith; Jose C Clemente Journal: Inflamm Bowel Dis Date: 2019-05-04 Impact factor: 5.325
Authors: L Clifford McDonald; Dale N Gerding; Stuart Johnson; Johan S Bakken; Karen C Carroll; Susan E Coffin; Erik R Dubberke; Kevin W Garey; Carolyn V Gould; Ciaran Kelly; Vivian Loo; Julia Shaklee Sammons; Thomas J Sandora; Mark H Wilcox Journal: Clin Infect Dis Date: 2018-03-19 Impact factor: 9.079
Authors: Allen A Lee; Krishna Rao; Julajak Limsrivilai; Merritt Gillilland; Benjamin Malamet; Emily Briggs; Vincent B Young; Peter D R Higgins Journal: Inflamm Bowel Dis Date: 2020-10-23 Impact factor: 5.325