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.
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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.
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The study was approved by the Institutional Review Board (Helsinki Committee) at RHCC.
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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.
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Bar-Yoseph, H., Daoud, H., Ben Hur, D. et al. Does early corticosteroid therapy affect prognosis in IBD patients hospitalized with Clostridioides difficile infection?. Int J Colorectal Dis 35, 513–519 (2020). https://doi.org/10.1007/s00384-019-03502-z
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DOI: https://doi.org/10.1007/s00384-019-03502-z