Clostridium difficile infection in hospitalized patients with inflammatory bowel disease

Maharshak, Nitsan; Barzilay, Idan; Zinger, Hasya; Hod, Keren; Dotan, Iris

doi:10.1097/md.0000000000009772

Cited by 32 publications

(34 citation statements)

References 58 publications

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“…di cile may explain recurrent course and poorer outcomes in IBD patients. [16,17] All isolates in the present study resisted cipro oxacin, and nearly all of these also resisted levo oxacin with the highest MICs (≥ 32 µg/ml − 1 ), resembling the hospital-acquired CDI in China. [5][6][7]9] However, merely 13.4% of isolates in IBD patients exhibited a resistance to moxi oxacin, which was signi cantly lower, when compared with the hospitalacquired CDI in China.…”

Section: Discussionmentioning

confidence: 55%

“…It has been suggested that the higher CDI in IBD patients could be partially explained by the increased CDI incidence in the general inpatient population. [11,16] It was also found that the CDI incidence in pediatric IBD patients was higher than that in adult IBD patients. As reported, IBD children had higher intermittent CDI, when compared to IBD adults.…”

Section: Discussionmentioning

confidence: 98%

“…In the present study, the detected incidence of CDI in adult IBD patients was lower than that reported in China, but comparable to the CDI frequency reported in non-Chinese IBD patients. [16,17,21,22] The different compositions in the general inpatient population in different hospitals may have tilted the CDI frequency one way or the other. It has been suggested that the higher CDI in IBD patients could be partially explained by the increased CDI incidence in the general inpatient population.…”

Section: Discussionmentioning

confidence: 99%

“…[10,11,14] Once CDI complicating IBD, IBD patients tend to have higher recurrent onsets that require repeated hospitalizations, and intensi ed antibiotic treatment and poorer outcomes, leading gastrointestinal surgery and higher mortality, when compared to mono-IBD. [16,17] Retrospective studies have revealed almost a two-fold higher risk for colectomy and a 4-6 fold increase in mortality risk among IBD patients with CDI. [18,19] IBD Patients were identi ed with discharge diagnoses codes, according to the International Classi cation of Diseases, 9th revision, Clinical Modi cation (ICD-9-CM).…”

Section: Introductionmentioning

confidence: 99%

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Molecular epidemiology of Clostridioides difficile in patients with inflammatory bowel disease in China

Chen

et al. 2019

Preprint

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Background: Clostridioides difficile (C. difficle) infection (CDI) in inflammatory bowel disease (IBD) patients can be recurrent, resulting in poor outcomes, but the molecular characterization of C. difficle in IBD patients remains to be well-established in China. This study aimed to investigate the molecular epidemiology of C. difficile in adult and pediatric IBD patients in China. Methods: C. difficile strains were isolated and identified from the fecal samples of adult and pediatric IBD patients. Toxigenic strains were typed using multilocus sequence typing (MLST), and susceptibility to 10 antimicrobials was evaluated using E-test.Results: Among the 838 IBD patients, 96 (11.5%) patients were positive for CDI, which comprised of 53 adult (9.6%) and 43 children (14.9%) cases. Isolates positive for both toxin A and toxin B genes (A+B+) accounted for 90.2% (74/82), while the remaining 9.8% were negative for toxin A, but positive for toxin B (A–B+). These toxigenic strains were susceptible to metronidazole and vancomycin, but highly resistant to clindamycin, levofloxacin, erythromycin and ciprofloxacin. Furthermore, the isolates obtained from pediatric patients had a significantly higher resistance rate to clindamycin, when compared to isolates obtained from adult CDI (p=0.009). In addition, these toxigenic strains were categorized as 18 sequence types (STs). The dominant types consisted of ST-35 (20.7%), ST-2 (17.1%), ST-54 (13.4%) and ST-3 (13.4%) in all patients, ST-2 (19.6%), ST-35 (15.2%) and ST-54 (13.0%) in adult patients, and ST-35 (27.8%), ST-3 (19.4%), ST-2 (13.9%), ST-54 (13.9%) and ST-37(8.3%) in pediatric patients, respectively. All isolates formed three distinct clusters in the phylogenetic analysis. Conclusions: The incidence and molecular epidemiology of C. difficile infection in adult IBD patients resembled CDI in the general inpatient population. A higher antibiotic resistance rate was identified among the C. difficile isolates obtained from pediatric IBD patients, and few STs accounted for most multidrug-resistant strains. However, the molecular genetic features of the same ST-type between these two groups remained highly correlated.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Molecular epidemiology of Clostridioides difficile in patients with inflammatory bowel disease in China

Chen

et al. 2019

Preprint

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“…In this study, the incidence of CDI among IBD patients was 24.6% (33/134) and was much higher than matched non IBD group. According to our knowldege, the infection rate of C. di cile in patients with IBD most studies reported in western countries is less than 10% and was much lower than this investigation [23,24]. The method they used to detect CDI was toxigenic culture or an algorithm, including glutamate dehydrogenase (GDH) and C. di cile toxin A or B (CDAB) with nucleic acid ampli cation testing (NAAT) as con rmatory test, respectively.…”

Section: Discussionmentioning

confidence: 68%

Characteristics of Clostridioides difficile infection in inflammatory bowel disease

Tang

Liu

Yan

et al. 2020

Preprint

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Background: The epidemiology of Clostridioides difficile infection(CDI) in China is different from western countries and the characteristics of CDI among inflammatory bowel disease (IBD) in China may be unique. The aim of this study was to investigate the molecular epidemiology and to find out the risk factors of CDI among IBD inpatients in Jiangsu Province, China. Methods: Patients with IBD admitted to the First Affiliated Hospital with Nanjing Medical University from August 2013 to December 2018 were enrolled. IBD patients were matched with non IBD patients according to age and gender. Diarrhea samples were sent for CDI diagnosis and the molecular epidemiology investigation was performed. Finally, patients’ information was collected and logistic regression analysis was performed to analyze the independent risk factors of CDI in IBD patients. Results: In this study, the incidence of CDI in IBD patients was much higher than that in non IBD patients (24.6% vs. 9.0%) and community acquired infection was the main kind. The predominant type of epidemic strain of C. difficile in this study was ST54. The shorter history of IBD and recent use of quinolone antibiotics were independent risk factors for CDI among diarrhea patients with IBD. Conclusion: If the duration of IBD is within one year or quinolone antibiotics have been used recently, clinicians should consider the possibility of IBD patients complicated with CDI and adjust the treatment plan.

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Complications of Inflammatory Bowel Disease: Initial Medical Management and Role of Endoscopy

Crews

Bohm

2019

Multidisciplinary Approaches to Common Surgical Problems

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Clostridium difficile infection in hospitalized patients with inflammatory bowel disease

Abstract: Supplemental Digital Content is available in the text

Cited by 32 publications

References 58 publications

Molecular epidemiology of Clostridioides difficile in patients with inflammatory bowel disease in China

Molecular epidemiology of Clostridioides difficile in patients with inflammatory bowel disease in China

Characteristics of Clostridioides difficile infection in inflammatory bowel disease

Complications of Inflammatory Bowel Disease: Initial Medical Management and Role of Endoscopy

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