Risk factors for Clostridium difficile diarrhea in patients with inflammatory bowel disease.

Abstract

BACKGROUND:

Despite the growing incidence of Clostridium difficile diarrhea (CCD) in patients with inflammatory bowel disease (IBD), little is known about the associated risk factors.

METHOD:

A retrospective study comparing cases of CCD in patients with IBD to IBD carriers who did not develop CCD. A comparison was also made with patients who developed CCD but did not suffer IBD.

RESULTS:

Three cases (20%) with IBD and CCD had received antibiotics during the previous three months versus none of the controls (IBD without CCD, p = 0.22). Ten cases (67%) received treatment with proton pump inhibitors (PPIs) versus 2 (13%) in the control group (IBD without CCD, p = 0.001). Seven cases underwent colonoscopy and pseudomembranes were seen in one (14%). Fourteen (93%) patients demonstrated a favourable response to metronidazole. Patients with IBD and CCD presented with younger age (36 ± 10 years), a higher degree of community-acquired infection (13 patients, 87%), immunosuppressive treatment (7 patients, 47%) and less patients had received previous antibiotic treatment (3 patients, 20%) than those with CCD without IBD. The proportion of patients who received treatment with PPIs was similar (66% and 80%, respectively p = 0.266).

CONCLUSIONS:

CCD in IBD carriers affects younger patients, the majority are community acquired (less nosocomial) and it is more related to previous treatment with PPIs than with the antibiotic treatment. Clinical evolution is also favourable.

• Authors: Antonio Ramos-Martínez, Jorge Ortiz-Balbuena, Isabel Curto-García, Ángel Asensio-Vegas, Rocío Martínez-Ruiz, Elena Múñez-Rubio, Mireia Cantero-Caballero, Isabel Sánchez-Romero, Irene González-Partida, María Isabel Vera-Mendoza
• Journal: Revista espanola de enfermedades digestivas (Rev Esp Enferm Dig) Vol. 107 Issue 1 Pg. 4-8 (Jan 2015) ISSN: 1130-0108 [Print] Spain
• PMID: 25603325 (Publication Type: Journal Article, Observational Study)

Chemical References

• Proton Pump Inhibitors

Topics

• Adult
• Age Factors
• Clostridioides difficile
• Community-Acquired Infections
• Cross Infection
• Diarrhea (drug therapy, etiology, microbiology)
• Enterocolitis, Pseudomembranous (complications, drug therapy, microbiology)
• Female
• Humans
• Inflammatory Bowel Diseases (complications, drug therapy, microbiology)
• Male
• Middle Aged
• Prospective Studies
• Proton Pump Inhibitors (therapeutic use)
• Risk Factors