Advertisement

Does early corticosteroid therapy affect prognosis in IBD patients hospitalized with Clostridioides difficile infection?

  • Haggai Bar-YosephEmail author
  • Haneen Daoud
  • Dana Ben Hur
  • Yehuda Chowers
  • Matti Waterman
Original Article
  • 19 Downloads

Abstract

Background

Corticosteroids (CS) therapy to Clostridioides difficile infection (CDI) in inflammatory bowel disease (IBD) flares may worsen CDI outcomes.

Aim

Assess the impact of early CS exposure on outcomes of IBD patients diagnosed with CDI.

Methods

Retrospective study of IBD patients admitted with first-time CDI between 2002 and 2018. Comparisons were made based on CS exposure 48 h from admission. Patients were further subdivided to 5 groups based on CS-antibiotics temporal exposure. The primary outcome was all-cause mortality or colectomy within 3 months. Secondary outcomes were colectomy and mortality rates at 1 year, length of stay, readmissions, bacteremia, and diarrhea improvement by day 7/discharge. Cox proportional hazard model and Kaplan-Meier curves were used to assess the effects on survival. Logistic and ordinal regressions were used to assess primary and secondary outcomes.

Results

One hundred thirteen patients (64 CD, 46 UC, and 3 IBDU) were included, 82 (72.5%) received early CS. At baseline, CRP was significantly lower and albumin was higher in the group not exposed to early CS. At 3 months, 4 (4.8%) patients required colectomy and 6 (5.8%) died (p = NS). Length of stay was significantly reduced among patients not exposed to early CS. All other endpoints were not associated with CS exposure. In subgroup analysis, the primary outcome was not significantly different among the sub-groups. Mortality rate at 1 year was significantly lower in patients who did not receive antibiotics for CDI.

Conclusion

Early CS therapy in IBD patients hospitalized with CDI is not associated with worse clinical outcomes. However, additional prospective research is required.

Keywords

Inflammatory bowel disease Clostridioides difficile Corticosteroids Antibiotics 

Notes

Authorship statement

Guarantor of the article: Haggai Bar-Yoseph. Specific author contributions: HBY, HD, DBH, and MW collected the data, HBY and MW conceived the study, HBY and HD wrote the paper, HBY, HD, DBH, MW, and YC contributed to the study design and analysis and critically reviewed the manuscript. All authors approved the final version of the article, including the authorship list.

Compliance with ethical standards

The study was approved by the Institutional Review Board (Helsinki Committee) at RHCC.

Conflict of interest

HBY, HD, and DBH have no conflict of interest to declare. MW has received a consultant and speaker fees for Takeda, Janssen, Abbvie, and Neopharm, and consultant fees for Medtronic and Pfizer. YC served as a consultant for Abbvie, Eli lilli, Janssen, Medtronics, Neopharm, Pfizer, Protalix, and Takeda, and received speaker’s fees for Abbvie, Janssen, and Takeda, and grants from Abbvie and Takeda.

Supplementary material

384_2019_3502_MOESM1_ESM.docx (198 kb)
ESM 1 (DOCX 153 kb).

References

  1. 1.
    Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR, Farley MM, Holzbauer SM, Meek JI, Phipps EC, Wilson LE, Winston LG, Cohen JA, Limbago BM, Fridkin SK, Gerding DN, McDonald L (2015) Burden of Clostridium difficile infection in the United States. N Engl J Med 372(9):825–834.  https://doi.org/10.1056/NEJMoa1408913 CrossRefPubMedGoogle Scholar
  2. 2.
    Khanna S, Shin A, Kelly CP (2017) Management of Clostridium difficile infection in inflammatory bowel disease: expert review from the clinical practice updates committee of the AGA Institute. Clin Gastroenterol Hepatol 15(2):166–174.  https://doi.org/10.1016/j.cgh.2016.10.024 CrossRefPubMedGoogle Scholar
  3. 3.
    Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH, McFarland L, Mellow M, Zuckerbraun BS (2013) Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol 108(4):478–498.  https://doi.org/10.1038/ajg.2013.4 CrossRefPubMedGoogle Scholar
  4. 4.
    Dignass A, Van Assche G, Lindsay JO et al (2010) The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: current management. J Crohn's Colitis 4(1):28–62.  https://doi.org/10.1016/j.crohns.2009.12.002 CrossRefGoogle Scholar
  5. 5.
    Dignass A, Lindsay JO, Sturm A, Windsor A, Colombel JF, Allez M, D'Haens G, D'Hoore A, Mantzaris G, Novacek G, Oresland T, Reinisch W, Sans M, Stange E, Vermeire S, Travis S, van Assche G (2012) Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management. J Crohn's Colitis 6(10):991–1030.  https://doi.org/10.1016/j.crohns.2012.09.002 CrossRefGoogle Scholar
  6. 6.
    Stuck AE, Minder CE, Frey FJ (1989) Risk of infectious complications in patients taking Glucocorticosteroids. Clin Infect Dis 11(6):954–963.  https://doi.org/10.1093/clinids/11.6.954 CrossRefGoogle Scholar
  7. 7.
    Singh H, Nugent Z, Yu BN, Lix LM, Targownik LE, Bernstein CN (2019) Higher incidence of Clostridium difficile infection among individuals with inflammatory bowel disease. Gastroenterology 153(2):430–438.e2.  https://doi.org/10.1053/j.gastro.2017.04.044 CrossRefGoogle Scholar
  8. 8.
    Ben-horin S, Margalit M, Bossuyt P et al (2019) Combination immunomodulator and antibiotic treatment in patients with inflammatory bowel disease and Clostridium difficile infection. YJCGH. 7(9):981–987.  https://doi.org/10.1016/j.cgh.2009.05.031 CrossRefGoogle Scholar
  9. 9.
    Ananthakrishnan AN, Guzman-Perez R, Gainer V, Cai T, Churchill S, Kohane I, Plenge RM, Murphy S (2012) Predictors of severe outcomes associated with Clostridium difficile infection in patients with inflammatory bowel disease. Aliment Pharmacol Ther 35(7):789–795.  https://doi.org/10.1111/j.1365-2036.2012.05022.x CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Das R, Feuerstadt P, Brandt LJ (2010) Glucocorticoids are associated with increased risk of short-term mortality in hospitalized patients with Clostridium difficile- associated disease. Am J Gastroenterol 105(9):2040–2049.  https://doi.org/10.1038/ajg.2010.142 CrossRefPubMedGoogle Scholar
  11. 11.
    Yanai H, Nguyen GC, Yun L, Lebwohl O, Navaneethan U, Stone CD, Ghazi L, Moayyedi P, Brooks J, Bernstein CN, Ben-Horin S (2011) Practice of gastroenterologists in treating flaring inflammatory bowel disease patients with clostridium difficile. Inflamm Bowel Dis 17(7):1540–1546.  https://doi.org/10.1002/ibd.21514 CrossRefPubMedGoogle Scholar
  12. 12.
    Sandora TJ, McDonald LC, Kelly C et al (2017) Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 66(7):e1–e48.  https://doi.org/10.1093/cid/cix1085 CrossRefGoogle Scholar
  13. 13.
    Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, Januel JM, Sundararajan V (2011) Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173(6):676–682.  https://doi.org/10.1093/aje/kwq433 CrossRefPubMedGoogle Scholar
  14. 14.
    Ananthakrishnan AN, McGinley EL, Saeian K, Binion DG (2011) Temporal trends in disease outcomes related to clostridium difficile infection in patients with inflammatory bowel disease. Inflamm Bowel Dis 17(4):976–983.  https://doi.org/10.1002/ibd.21457 CrossRefPubMedGoogle Scholar
  15. 15.
    Dirweesh A, Alvarez C, Khan M, Ambreen B (2017) Lack of association between the clinical outcome of infection and current steroids use. Gastroenterology Res 10(2):116–119CrossRefGoogle Scholar
  16. 16.
    Tkhawkho L, Nitzan O, Pastukh N, Brodsky D, Jackson K, Peretz A (2017) Antimicrobial susceptibility of Clostridium difficile isolates in Israel. J Glob Antimicrob Resist.  https://doi.org/10.1016/j.jgar.2017.04.005 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of GastroenterologyRambam Health Care CampusHaifaIsrael
  2. 2.Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael
  3. 3.Department of Internal Medicine HRambam Health Care CampusHaifaIsrael
  4. 4.Clinical Research InstituteRambam Health Care CampusHaifaIsrael

Personalised recommendations