Digestive Diseases and Sciences

, Volume 63, Issue 4, pp 1016–1024 | Cite as

Risk Factors for Clostridium difficile Isolation in Inflammatory Bowel Disease: A Prospective Study

  • Dejan Micic
  • Andres Yarur
  • Alex Gonsalves
  • Vijaya L. Rao
  • Susan Broadaway
  • Russell Cohen
  • Sushila Dalal
  • John N. Gaetano
  • Laura R. Glick
  • Ayal Hirsch
  • Joel Pekow
  • Atsushi Sakuraba
  • Seth T. Walk
  • David T. RubinEmail author
Original Article



Clostridium difficile is the most commonly isolated stool pathogen in inflammatory bowel disease (IBD). Traditional risk factors for C. difficile may not exist in patients with IBD, and no prior studies have assessed the risk factors for the isolation of C. difficile in both symptomatic and asymptomatic IBD outpatients.


We prospectively recruited consecutive IBD patients presenting to our outpatient clinic between April 2015 and February 2016. We excluded patients with a diverting ostomy or ileoanal pouch. Demographics, healthcare exposures, medical therapies and disease activity were recorded from medical charts or surveys. A rectal swab was performed from which toxigenic culture and PCR analysis for the presence of toxin and fluorescent PCR ribotyping were performed. The primary outcome of interest was isolation of toxigenic C. difficile.


A total of 190 patients were enrolled in this prospective study including 137 (72%) with Crohn’s disease and 53 (28%) with ulcerative colitis. At the time of enrollment, 69 (36%) had clinically active disease. Sixteen (8.4%) patients had toxigenic C. difficile isolated on rectal swab at enrollment and four (2.1%) patients had non-toxigenic C. difficile cultured. Mixed infection with more than one toxigenic isolate was present in 5/16 (33.3%) individuals. Patients with CD with a toxin positive isolate were more likely to have a history of CDI in the past 12 months (40 vs. 11.02%, p = 0.027) and an emergency department visit in the past 12 weeks (50 vs. 20.63%, p = 0.048). In UC, individuals with isolation of C. difficile were more likely to be hospitalized within the past 12 months (66.6 vs. 8.51%, p = 0.003). C. difficile isolation at the time of presentation was not associated with a subsequent disease relapse over a 6-month period in CD (p = 0.557) or UC (p = 0.131).


Healthcare exposures remain a significant risk factor for C. difficile isolation in the IBD population; however, this was not associated with relapse of disease. Further studies assessing the clinical significance of C. difficile isolation is warranted in IBD.


Inflammatory bowel disease Ulcerative colitis Crohn’s disease Clostridium difficile 



Crohn’s disease


Ulcerative colitis


Inflammatory bowel disease



This work was supported by grants from the National Institutes of Health [Grant Nos. T32DK007074, K08DK090152 (JP), P30DK42086]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

No expressed conflicts of interest with respect to the submitted work.

Supplementary material

10620_2018_4941_MOESM1_ESM.docx (104 kb)
Supplementary material 1 (DOCX 103 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Dejan Micic
    • 1
  • Andres Yarur
    • 1
  • Alex Gonsalves
    • 1
  • Vijaya L. Rao
    • 1
  • Susan Broadaway
    • 2
  • Russell Cohen
    • 1
  • Sushila Dalal
    • 1
  • John N. Gaetano
    • 1
  • Laura R. Glick
    • 1
  • Ayal Hirsch
    • 1
  • Joel Pekow
    • 1
  • Atsushi Sakuraba
    • 1
  • Seth T. Walk
    • 2
  • David T. Rubin
    • 1
    Email author
  1. 1.University of Chicago Medicine Inflammatory Bowel Disease CenterChicagoUSA
  2. 2.Montana State UniversityBozemanUSA

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