Yiting Li1,2, Haifeng Cai3, Daniel A Sussman4, Jean Donet5, Kevin Dholaria6, Jiajia Yang7, Ami Panara4, Ryan Croteau8, Jamie S Barkin9. 1. Department of Internal Medicine, Saint Francis Medical Center, Trenton, NJ, USA. 2. Division of Gastroenterology and Hepatology, University of New Mexico, School of Medicine, Albuquerque, NM, USA. 3. Department of Orthopaedics, The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, 109 Xue Yuan Xi Road, Wenzhou, 325000, Zhejiang, China. 4. Division of Gastroenterology, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL, USA. 5. Department of Gastroenterology and Hepatology, University of California, San Francisco, Fresno, CA, USA. 6. PIH Health, Downey, CA, USA. 7. University of South Florida, Morsani College of Medicine, Tampa, FL, USA. 8. Department of Gastroenterology, Wellspan Digestive Health, York, PA, USA. 9. Division of Gastroenterology, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL, USA. jsbarkin@med.miami.edu.
Abstract
BACKGROUND: Patients with Clostridioides difficile infection (CDI) often have coexisting medical problems requiring immunosuppressive therapy. However, limited data are available on the association between immunosuppressive therapy and CDI outcomes. AIM: To determine the association between immunosuppressive therapy and CDI outcomes. METHODS: PubMed, Embase, and Cochrane Library were searched through February 2021. Two reviewers independently reviewed and included studies that compared adult CDI patients who received immunosuppressive therapy to those who did not. The primary outcome was complicated CDl, including death, surgery, shock, or ICU admission. Raw data or unadjusted odds ratios (ORs) were used to calculate pooled ORs with 95% confidence intervals (CIs). RESULTS: Twenty-two studies with a total of 5759 CDI patients were selected. Immunosuppressive therapy was significantly associated with both primary outcome and death, with pooled ORs of 1.61 (95% CI 1.33-1.96) and 1.73 (95% CI 1.39-2.15) separately. The association between corticosteroids and primary outcome was also significant with OR of 1.73 (95% CI 1.41, 2.12). In subgroup analysis, the factors explaining differences in study results included study quality, patient age, and whether individual studies had adjusted for potential confounders. In a systematic review, most studies suggested a positive association between immunosuppressive therapy and complicated outcomes of CDI in patients comorbid for IBD. CONCLUSIONS: Our systematic review and meta-analysis demonstrate that immunosuppressive therapy is a risk factor for complicated outcomes of CDI.
BACKGROUND: Patients with Clostridioides difficile infection (CDI) often have coexisting medical problems requiring immunosuppressive therapy. However, limited data are available on the association between immunosuppressive therapy and CDI outcomes. AIM: To determine the association between immunosuppressive therapy and CDI outcomes. METHODS: PubMed, Embase, and Cochrane Library were searched through February 2021. Two reviewers independently reviewed and included studies that compared adult CDI patients who received immunosuppressive therapy to those who did not. The primary outcome was complicated CDl, including death, surgery, shock, or ICU admission. Raw data or unadjusted odds ratios (ORs) were used to calculate pooled ORs with 95% confidence intervals (CIs). RESULTS: Twenty-two studies with a total of 5759 CDI patients were selected. Immunosuppressive therapy was significantly associated with both primary outcome and death, with pooled ORs of 1.61 (95% CI 1.33-1.96) and 1.73 (95% CI 1.39-2.15) separately. The association between corticosteroids and primary outcome was also significant with OR of 1.73 (95% CI 1.41, 2.12). In subgroup analysis, the factors explaining differences in study results included study quality, patient age, and whether individual studies had adjusted for potential confounders. In a systematic review, most studies suggested a positive association between immunosuppressive therapy and complicated outcomes of CDI in patients comorbid for IBD. CONCLUSIONS: Our systematic review and meta-analysis demonstrate that immunosuppressive therapy is a risk factor for complicated outcomes of CDI.
Authors: Christina M Surawicz; Lawrence J Brandt; David G Binion; Ashwin N Ananthakrishnan; Scott R Curry; Peter H Gilligan; Lynne V McFarland; Mark Mellow; Brian S Zuckerbraun Journal: Am J Gastroenterol Date: 2013-02-26 Impact factor: 10.864
Authors: Stephan J Ott; Georg H Waetzig; Ateequr Rehman; Jacqueline Moltzau-Anderson; Richa Bharti; Juris A Grasis; Liam Cassidy; Andreas Tholey; Helmut Fickenscher; Dirk Seegert; Philip Rosenstiel; Stefan Schreiber Journal: Gastroenterology Date: 2016-11-17 Impact factor: 22.682
Authors: Colleen R Kelly; Chioma Ihunnah; Monika Fischer; Alexander Khoruts; Christina Surawicz; Anita Afzali; Olga Aroniadis; Amy Barto; Thomas Borody; Andrea Giovanelli; Shelley Gordon; Michael Gluck; Elizabeth L Hohmann; Dina Kao; John Y Kao; Daniel P McQuillen; Mark Mellow; Kevin M Rank; Krishna Rao; Arnab Ray; Margot A Schwartz; Namita Singh; Neil Stollman; David L Suskind; Stephen M Vindigni; Ilan Youngster; Lawrence Brandt Journal: Am J Gastroenterol Date: 2014-06-03 Impact factor: 10.864