Escalation of Immunosuppressive Therapy for Inflammatory Bowel Disease Is Not Associated With Adverse Outcomes After Infection With<i>Clostridium difficile</i>

Lukin, Dana J.; Lawlor, Garrett; Hudesman, David; Durbin, Laura; Axelrad, Jordan E.; Passi, Monica; Cavaliere, Kimberly; Coburn, Elliot; Loftus, Michelle; Jen, Henry; Feathers, Alexandra; Rosen, Melissa; Malter, Lisa; Swaminath, Arun; Study, IBD-ReMEdY

doi:10.1093/ibd/izy308

Cited by 17 publications

(16 citation statements)

References 15 publications

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“…A multicenter retrospective cohort analyzed IBD patients complicated with CDI and found that immunosuppressive therapy escalation (with corticosteroids or biologic agents) within 90 days of CDI was not associated with worse clinical outcomes. 49 Another retrospective cohort illustrated that within 3 months of admission, there was a 12% rate of adverse outcomes of in-hospital megacolon, bowel perforation, shock, respiratory failure, colectomy, or death in patients managed with antibiotics and immunosuppression (including prednisone, thiopurines, methotrexate, cyclosporine, tacrolimus, or biologics of any kind). 50 These adverse outcomes were not observed in patients who were managed with antibiotics alone.…”

Section: Managing Ibd In Patients With Ibd and CDImentioning

confidence: 99%

The interplay of Clostridioides difficile infection and inflammatory bowel disease

Sehgal

Yadav

Khanna

2021

Therap Adv Gastroenterol

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Inflammatory bowel disease (IBD) is a chronic disease of the intestinal tract that commonly presents with diarrhea. Clostridioides difficile infection (CDI) is one of the most common complications associated with IBD that lead to flare-ups of underlying IBD. The pathophysiology of CDI includes perturbations of the gut microbiota, which makes IBD a risk factor due to the gut microbial alterations that occur in IBD, predisposing patients CDI even in the absence of antibiotics. Superimposed CDI not only worsens IBD symptoms but also leads to adverse outcomes, including treatment failure and an increased risk of hospitalization, surgery, and mortality. Due to the overlapping symptoms and concerns with false-positive molecular tests for CDI, diagnosing CDI in patients with IBD remains a clinical challenge. It is crucial to have a high index of suspicion for CDI in patients who seem to be experiencing an exacerbation of IBD symptoms. Vancomycin and fidaxomicin are the first-line treatments for the management of CDI in IBD. Microbiota restoration therapies effectively prevent recurrent CDI in IBD patients. Immunosuppression for IBD in IBD patients with CDI should be managed individually, based on a thorough clinical assessment and after weighing the pros and cons of escalation of therapy. This review summarizes the epidemiology, pathophysiology, the diagnosis of CDI in IBD, and outlines the principles of management of both CDI and IBD in IBD patients with CDI.

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Section: Managing Ibd In Patients With Ibd and CDImentioning

confidence: 99%

The interplay of Clostridioides difficile infection and inflammatory bowel disease

Sehgal

Yadav

Khanna

2021

Therap Adv Gastroenterol

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“…Microbiological safety in IBD is relevant considering the frequent use of corticosteroid, immunomodulators, and anti-TNF-alpha antibody therapy in these patients. 11,12 Especially, after the recent FDA report of mortality and morbidity in immunocompromised patients due to an FMT-acquired enteropathogenic Escherichia coli infection, as well as other reports of Shigatoxin-producing Escherichia coli, following the investigational use of FMT. 13 More recent studies documenting the presence of the respiratory SARS-CoV-2 (COVID-19) virus in the stool of infected individuals, [14][15][16][17][18] also further illustrate the need for proper screening and selection of donor stool for FMT.…”

Section: Introductionmentioning

confidence: 99%

Autologous fecal microbiota transplantation for the treatment of inflammatory bowel disease

Basson

Zhou

Seo

et al. 2020

Translational Research

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The term autologous fecal microbiota transplantation (a-FMT) refers herein to the use of one's feces during a healthy state for later use to restore gut microbial communities after perturbations. Generally, heterologous fecal microbiota transplantation (h-FMT), where feces from a ''healthy" donor is transplanted into a person with illness, has been used to treat infectious diseases such as recurrent Clostridioides difficile infection (CDI), with cure rates of up to 90%. In humans, due to limited response to medicines, h-FMT has become a hallmark intervention to treat CDI. Extrapolating the benefits from CDI, h-FMT has been attempted in various diseases, including inflammatory bowel disease (IBD), but clinical response has been variable and less effective (ranging between 24% and 50%). Differences in h-FMT clinical response could be because CDI is caused by a Clostridial infection, whereas IBD is a complex, microbiome-driven immunological inflammatory disorder that presents predominantly within the gut wall of geneticallysusceptible hosts. FMT response variability could also be due to differences in microbiome composition between donors, recipients, and within individuals, which vary with diet, and environments, across regions. While donor selection has emerged as a key factor in FMT success, the use of heterologous donor stool still places the recipient at risk of exposure to infectious/pathogenic microorganisms. As an implementable solution, herein we review the available literature on a-FMT, and list some considerations on the benefits of a-FMT for IBD. (Translational Research 2020; 226:1À11) Abbreviation: a-FMT = autologous fecal microbiota transplantation; CD = Crohn's disease; CDI = Clostridium difficile infection; CI = Confidence interval; FMT = Fecal microbiota transplantation; hGM = human gut microbiota; h-FMT = heterologous fecal microbiota transplantation; IBD = inflammatory bowel disease; IBS = irritable bowel syndrome; RCT = randomized controlled trial; UC = ulcerative colitis

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“…A retrospective study suggested that the likelihood of severe outcomes was lower in patients who had an escalation of IBD therapy after CDI. 66 In another retrospective cohort study, increasing corticosteroids for IBD while complicated by CDI was associated with a higher risk of downstream colon surgery but adverse outcomes did not differ with modification of dosing of biologic or immunomodulator regimens. 67 A similar retrospective cohort study was performed to answer the question if early corticosteroid therapy affected outcomes in IBD patients hospitalized with CDI.…”

Section: Medical Treatment Of Ibd Complicated By CDImentioning

confidence: 96%

“…A recent study where 30% patients had an escalation to biologic or corticosteroid therapy, did not have increased severe outcomes. A retrospective study suggested that the likelihood of severe outcomes was lower in patients who had an escalation of IBD therapy after CDI [ 66 ]. In another retrospective cohort study, increasing corticosteroids for IBD while complicated by CDI was associated with a higher risk of downstream colon surgery but adverse outcomes did not differ with modification of dosing of biologic or immunomodulator regimens [ 67 ].…”

Section: Medical Treatment Of Ibd Complicated By CDImentioning

confidence: 99%

Management of Clostridioides difficile infection in patients with inflammatory bowel disease

Khanna

2021

Intest Res

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tered gut microbiota is colonization and infection with opportunistic microorganisms such as Clostridioides difficile. Studies over the years have demonstrated that the commonest infectious complication and the leading cause of a disease flareup in patients with IBD is C. difficile infection (CDI). 3 In contrast, non-C. difficile bacterial infections are uncommon in IBD patients with a disease flare. 4 Clostridioides difficile (formerly Clostridium difficile also known as C. difficile or C. diff) is an anaerobic Gram-positive spore forming bacterium that is ubiquitous in our environment. 5 Exposure to the C. difficile bacterium (spore or vegetative form) can lead to spectrum of outcomes ranging from no effect and no colonization to asymptomatic colonization to mild-moderate illness to severe diarrhea to fulminant lifethreatening infection. 6 It is now well-recognized that IBD patients are at a high risk of developing CDI even in the absence of other traditional risk factors. 3 In 2017, the American Gastroenterological Association released an expert clinical practice

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Escalation of Immunosuppressive Therapy for Inflammatory Bowel Disease Is Not Associated With Adverse Outcomes After Infection WithClostridium difficile

Cited by 17 publications

References 15 publications

The interplay of Clostridioides difficile infection and inflammatory bowel disease

The interplay of Clostridioides difficile infection and inflammatory bowel disease

Autologous fecal microbiota transplantation for the treatment of inflammatory bowel disease

Management of Clostridioides difficile infection in patients with inflammatory bowel disease

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