Article

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

ABSTRACT

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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    • "In health care settings, methicillin-resistantStaphylococcus aureus (MRSA), Vancomycin-resistant Enterococcus (VRE), Acinetobacter infection and Clostridium difficile are the most common pathogens causing HAIs, which affect the length of hospitalization, and also affects patients' morbidity and mortality (BOP, 2012;Daniels et al., 2008;Patel, 2003). This cost the health-care organization billions of dollars every year and it associated with long-term impact on patients' quality of life (Navaneethan et al., 2012;Rodemann et al., 2007;Issa et al, 2007). For these reasons, performing effective hand hygiene becomes necessary to save lives. "

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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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