Harminder Singh1, Zoann Nugent2, B Nancy Yu3, Lisa M Lix4, Laura E Targownik5, Charles N Bernstein5. 1. Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada; Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: Harminder.singh@umanitoba.ca. 2. Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada; Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada. 3. Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Public Health Branch, Manitoba Health, Seniors and Active Living, Winnipeg, Manitoba, Canada. 4. Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. 5. Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada.
Abstract
BACKGROUND & AIMS: Studies of Clostridium difficile infections (CDIs) among individuals with inflammatory bowel disease (IBD) have used data from single centers or CDI administrative data codes of limited diagnostic accuracy. We determined the incidence, risk factors, and outcomes after CDI in a population-based cohort of patients with IBD and laboratory confirmation diagnoses of CDI. METHODS: We searched the University of Manitoba IBD Epidemiology Database and Manitoba Health CDI databases to identify individuals with CDI, with or without IBD, from July 1, 2005 through March 31, 2014. Time trends of incidence were assessed using joinpoint regression. Multivariable Cox regression analyses were performed to assess differences in CDI incidence rates and mortality after CDI between individuals with and without IBD. Conditional logistic regression was performed to determine predictors of CDI among individuals with IBD. RESULTS: Individuals with IBD had a 4.8-fold increase in risk of CDI than individuals without IBD; we found no difference between individuals with ulcerative colitis vs Crohn's disease. There was no increase in CDI incidence over the study time period in either group. Among individuals with IBD, exposure to corticosteroids, infliximab or adalimumab, metronidazole, hospitalizations, higher ambulatory care visits, shorter duration of IBD, and higher comorbidities were associated with an increased risk of CDI. Although CDI increased mortality among individuals with and without IBD, there was lower mortality after CDI among individuals with IBD than without IBD (hazard ratio, 0.65; 95% confidence interval, 0.44-0.96). CONCLUSIONS: CDI incidence is no longer increasing among individuals with IBD. We identified unique risk factors for CDI in patients with IBD. CDI is associated with a greater increase in mortality among individuals without IBD than with IBD.
BACKGROUND & AIMS: Studies of Clostridium difficile infections (CDIs) among individuals with inflammatory bowel disease (IBD) have used data from single centers or CDI administrative data codes of limited diagnostic accuracy. We determined the incidence, risk factors, and outcomes after CDI in a population-based cohort of patients with IBD and laboratory confirmation diagnoses of CDI. METHODS: We searched the University of Manitoba IBD Epidemiology Database and Manitoba Health CDI databases to identify individuals with CDI, with or without IBD, from July 1, 2005 through March 31, 2014. Time trends of incidence were assessed using joinpoint regression. Multivariable Cox regression analyses were performed to assess differences in CDI incidence rates and mortality after CDI between individuals with and without IBD. Conditional logistic regression was performed to determine predictors of CDI among individuals with IBD. RESULTS: Individuals with IBD had a 4.8-fold increase in risk of CDI than individuals without IBD; we found no difference between individuals with ulcerative colitis vs Crohn's disease. There was no increase in CDI incidence over the study time period in either group. Among individuals with IBD, exposure to corticosteroids, infliximab or adalimumab, metronidazole, hospitalizations, higher ambulatory care visits, shorter duration of IBD, and higher comorbidities were associated with an increased risk of CDI. Although CDI increased mortality among individuals with and without IBD, there was lower mortality after CDI among individuals with IBD than without IBD (hazard ratio, 0.65; 95% confidence interval, 0.44-0.96). CONCLUSIONS: CDI incidence is no longer increasing among individuals with IBD. We identified unique risk factors for CDI in patients with IBD. CDI is associated with a greater increase in mortality among individuals without IBD than with IBD.
Authors: Daryl Ramai; Khoi Paul Dang-Ho; Chris Lewis; Paul J Fields; Andrew Ofosu; Mohamed Barakat; Ali Aamar; Emmanuel Ofori; Jonathan Lai; Gandhi Lanke; Amaninder Dhaliwal; Madhavi Reddy; James Gasperino Journal: Int J Colorectal Dis Date: 2020-06-17 Impact factor: 2.571
Authors: Jessica Breton; Arthur Kastl; Natalie Hoffmann; Rachel Rogers; Andrew B Grossman; Petar Mamula; Judith R Kelsen; Robert N Baldassano; Lindsey Albenberg Journal: Inflamm Bowel Dis Date: 2019-08-20 Impact factor: 5.325
Authors: Dejan Micic; Andres Yarur; Alex Gonsalves; Vijaya L Rao; Susan Broadaway; Russell Cohen; Sushila Dalal; John N Gaetano; Laura R Glick; Ayal Hirsch; Joel Pekow; Atsushi Sakuraba; Seth T Walk; David T Rubin Journal: Dig Dis Sci Date: 2018-02-08 Impact factor: 3.199