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



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


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


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.


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.


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


Inflammatory bowel disease Clostridioides difficile Corticosteroids Antibiotics 


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).


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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

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