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Impact of superimposed Clostridium difficile infection in Crohn’s or ulcerative colitis flares in the outpatient setting

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Abstract

Purpose

The prospective assessment of Clostridium difficile infection (CDI) impact in inflammatory bowel disease (IBD) flare in outpatient setting has been poorly investigated. We aimed to evaluate the prevalence and the associated factors with CDI in IBD outpatients presenting colitis flares as well as the outcomes following treatment.

Methods

In this prospective cohort study, conducted from October, 2014, to July, 2016, 120 IBD patients (55% presenting colitis flare) and 40 non-IBD controls were assessed for CDI. Multivariate regression analysis was performed to identify predictors of CDI. Outcome analysis was estimated for recurrent CDI, hospitalization, colectomy, and CDI-associated mortality.

Results

The number of patients with CDI was significantly higher in IBD patients experiencing flares than in both inactive IBD and non-IBD groups (28.8 vs. 5.6 vs. 0%, respectively; p = 0.001). Females (OR = 1.39, 95% CI, 1.13–17.18), younger age (OR = 0.77, 95% CI, 0.65–0.92), steroid treatment (OR = 7.42, 95% CI, 5.17–40.20), and infliximab therapy (OR = 2.97, 95% CI, 1.99–24.63) were found to be independently associated with CDI. There was a dose-related increase in the risks of CDI on patients which had taken prednisone. Those treated with vancomycin had a satisfactory response to therapy, but 21% presented recurrent CDI and 16% were hospitalized. Neither necessity of colectomy nor mortality was noticed in any patient during the investigation.

Conclusions

In IBD outpatients presenting colitis flares, CDI is highly prevalent. Females, younger age, infliximab, and notably steroid therapy were independently associated with CDI. Most patients with CDI experienced mild-to-moderate disease, and prompt treatment with vancomycin was highly effective, which seems to reduce the serious complication risks.

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Funding source

This work was supported by a clinical research fund from the National Council of Scientific Researches (CNPq), Brazil.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Maria José Leal Street, 296, Juiz de Fora, MG, CEP 36036-247, Brazil

    Patrícia Guedes Garcia, Liliana Andrade Chebli, Tarsila Campanha da Rocha Ribeiro, Pedro Duarte Gaburri, Fabio Heleno de Lima Pace, Kátia Valéria Bastos Dias Barbosa, Lívia Almeida Costa, William de Almeida Cruz, Isabelle Carvalho de Assis, Bernardo Rodriguez Mendes Moraes, Alexandre Zanini & Julio Maria Fonseca Chebli

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  1. Patrícia Guedes Garcia
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Contributions

PGG, LAC, TCRR, PDG, and FHLP: study concept and design, acquisition, analysis and interpretation of data, and manuscript writing. WAC, ICA, and BRMM: manuscript critical revision, study design, and interpretation of data. AZ: statistical analysis, review and interpretation of data, and manuscript critical revision. ACSC, KVBDB, LAC, and ROR: data analysis and interpretation and manuscript critical revision. JMFC: study concept and design, acquisition, analysis and interpretation of data, manuscript writing, and study supervision.

All authors approved the final draft.

Corresponding author

Correspondence to Julio Maria Fonseca Chebli.

Ethics declarations

The study protocol was defined in accordance with the Declaration of Helsinki and was approved by our Institutional Ethics Committee. All patients signed a freely informed consent form before being admitted to the study.

Financial disclosure

All authors have no financial relationships relevant to this article to disclose.

Conflicts of interest

Julio M F Chebli has received speaker fees from Abbott, Abbvie, Janssen, Takeda.

The remaining authors disclose no conflicts.

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Garcia, P.G., Chebli, L.A., da Rocha Ribeiro, T.C. et al. Impact of superimposed Clostridium difficile infection in Crohn’s or ulcerative colitis flares in the outpatient setting. Int J Colorectal Dis 33, 1285–1294 (2018). https://doi.org/10.1007/s00384-018-3105-8

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