Rodemann JF, Dubberke ER, Reske KA. Incidence of Clostridium difficile infection in inflammatory bowel disease

Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri 63110, USA.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association (Impact Factor: 7.9). 04/2007; 5(3):339-44. DOI: 10.1016/j.cgh.2006.12.027
Source: PubMed


Clostridium difficile-associated disease (CDAD) rates have been increasing. We sought to determine whether CDAD incidence has increased specifically in hospitalized patients with IBD. We also explored possible differences in the risk for and time to presentation of CDAD between IBD and non-IBD patients.
We analyzed hospital admissions from 1998-2004 for demographics, length of stay, C difficile infections, and time from admission to a positive C difficile test. We calculated CDAD incidence for non-IBD, all IBD, CD, and UC admissions and used logistic regression to estimate the risk for CDAD.
CDAD incidence increased in each group and was higher in all IBD than non-IBD groups. During the observation period, CDAD rates approximately doubled in CD (9.5 to 22.3/1000 admissions) and tripled in UC (18.4 to 57.6/1000). Length of stay was similar among the groups. For all years combined, the adjusted odds ratios for CDAD in all IBD, CD, and UC admissions were 2.9 (95% confidence interval, 2.1-4.1), 2.1 (1.3-3.4), and 4.0 (2.4-6.6), respectively. The median times from admission to a positive C difficile test result for non-IBD, CD, and UC were 4.0, 0.8, and 0.5 days, respectively.
CDAD incidence in IBD has increased and is higher than in the non-IBD population. IBD and UC patients in particular have a higher risk for CDAD. C difficile infections in IBD are confirmed predominantly within 48 hours of admission, suggesting most were acquired before hospitalization.

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    • "on univariable analysis. CDI is also associated with increased morbidity and mortality in patients with IBD [43]. By contrast, disease severity in HSCT recipients is often reported as mild [44]. "
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    ABSTRACT: Clostridium difficile infection (CDI) is an emerging problem worldwide associated with significant morbidity, mortality, recurrence rates and healthcare costs. Immunosuppressed patients, including HIV-seropositive individuals, solid organ transplant recipients, patients with malignancies, hematopoietic stem cell transplant recipients, and patients with inflammatory bowel disease are increasingly recognized as being at higher risk of developing CDI where it may be associated with significant complications, recurrence, and mortality. Fecal microbiota transplantation (FMT) has proven to be an effective and safe procedure for the treatment of recurrent or refractory CDI in immunocompetent patients by restoring the gut microbiota and resistance to further recurrences. During the last two years the first data on FMT in immunocompromised patients began to appear in the medical literature. Herein we summarize the use of FMT for the treatment of CDI with a focus on immunocompromised patients. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
    Journal of Infection and Chemotherapy 01/2015; 21(4). DOI:10.1016/j.jiac.2015.01.011 · 1.49 Impact Factor
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    • "There is little data on the recurrence of CDAD in patients with IBD. Noteworthy studies have been carried out by Rodemann et al., who showed a lower relapse rate among patients with IBD than in the general population (0.1% vs. 8.7%) [31]. Further studies are needed to assess the recurrence of CDI, but it should be noted that when they occur, treatment regimens should be the same as those recommended as in the general population [25, 26]. "
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    ABSTRACT: Clostridium difficile is a bacterium widely distributed in the human environment. In the last decade the incidence and severity of Clostridium difficile infection has grown, particularly in Europe and North America, making it one of the more common nosocomial infections. A group particularly susceptible to Clostridium difficile infection are patients with inflammatory bowel disease, especially those with involvement of the colon. This paper presents relevant data on Clostridium difficile infections in inflammatory bowel disease patients, including epidemiology, pathogenesis, diagnosis and treatment.
    Przegląd Gastroenterologiczny 06/2014; 9(3):125-9. DOI:10.5114/pg.2014.43572 · 0.38 Impact Factor
    • "Additional risk factors include advanced age (older than 65 years), longer hospital stay, increased numbers of morbidities, taking immunosuppressive medications or chemotherapy, recent gastrointestinal (GI) surgery, inflammatory bowel disease, and history of CDI in the past. Recently, proton pump inhibitors are also believed to increase the risk of CDI, possibly by gastric acid suppression.[121314151617] "
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    ABSTRACT: Clostridium difficile infection (CDI) is currently a leading cause of antibiotic and health care-related diarrhea. The incidence and the severity of CDI-related diarrhea have increased dramatically in the USA and Europe in the past few decades. The emergence of multidrug-resistant hypervirulent strains of C. difficile has led to an increase in mortality. Fecal microbiota transplantation (FMT) (also known as fecal bacteriotherapy) has been utilized sporadically since the 1950s; and currently, the interest in using FMT has grown again in the past few years for the treatment of CDI and other chronic gastrointestinal diseases. FMT has shown to be effective, cheap, and has very few side effects. It is believed to manipulate and restore the gut microbiota, and therefore enhances the growth of "healthy" bacteria that break the cycle of recurrent CDI. This article focus on the recent case reports on FMT, and general approach to patients undergoing this therapy. Data were obtained through a literature search via PubMed and Google.
    North American Journal of Medical Sciences 06/2013; 5(6):339-43. DOI:10.4103/1947-2714.114163
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