IBD Patients More Likely to Develop C Difficile Infections

New research sheds some light on the risk factors that increase the prevalence of Clostridioides difficile infections (CDI) for patients with inflammatory bowel disease (IBD).

A team, led by N. Fadeeva, A.S. Loginov Moscow Clinical Scientific Center, Department for IBD, Moscow, Russian Federation, defined the frequency of CDI in patients with IBD, while identifying the risk factors that predict severe outcomes in this patient population.

The data was presented during the 16th Congress of European Crohn's and Colitis Organisation (ECCO).

IBD patients generally have a higher prevalence of CDI when compared to the general population and the infection could produce a negative effect on the clinical course of IBD.

The Patients

In the retrospective study, the researchers analyzed the data of 1278 medical records of IBD patients and included 808 individuals in the final analysis.

The patients were divided into 2 different cohorts based on the presence of a preliminary diagnosis of a C difficile infection.

The researchers sought primary outcomes of the time to total colectomy or death with follow-up censored at 180 days following a CDI diagnosis. The researchers used Pearson Chi-square and two-sample t-tests for the statistical analysis.

17.6% of IBD patients also had C difficile infections in the study and the mean age of occurrence was 37.8±12.9.

The first group involved 143 patients with CDI and the second group had 665 IBD patients without a concurrent infection.

Trends

C-reactive protein, erythrocyte sedimentation rate and fecal calprotectin levels were significantly higher in the first group than it was in the second group. However, albumin levels were lower in the first group than it was in the second group (P <0.05).

For the first group, the average albumin level was 20.8±1.83 mg/l compared to – 38.7±2.36 mg/l (P <0.05) for the second group.

For treatments, only 25.3% of patients with CDI had a history of antibiotic use, while 30.4% had a history of steroid use.

One trend was that long-term immunosuppressive treatment for IBD has a relation to the development of CDI. For the patients with C difficile, 48.7% long-term received azathioprine/6-mercaptopurine.

In patients without CDI this was only 18.3% (P <0.001).

In addition, only 19% of patients had control of the disease after salicylates treatment and 62% of patients without CDI achieved clinical remission by taking salicylates (P <0.05). Of this group, 4.9% (n = 7) met the primary outcome—1 death, 6 colectomy—at a median of 21 days.

Using a multivariate analysis, the researchers found serum albumin<22 mg/L (HR, 7.93; 95% CI, 1.006-62.57), was independent predictors of the primary outcome.

“The frequency of CDI in patients with IBD was 17.6%. The study shows that patients with IBD are more sensitive to the development of CDI at a young age, while not having such traditional risk factors as recent hospitalization or antibiotic use,” the authors wrote. “Patients with IBD with CDI in history often noted the ineffectiveness of therapy with salicylates; often require the assignment of biological therapy. IBD patients with CDI have a lower average albumin, and a higher activity of the inflammatory process (p<0.05). Serum albumin<22 mg/L was independent predictors of severe outcomes in hospitalized IBD patients with CDI.”

The study, “Clostridium Difficile Infection as a cause of severe outcomes in patients with Inflammatory Bowel Disease,” was published online by the European Crohn’s and Colitis Organisation.