Lasting Impact of Clostridium difficile Infection in Inflammatory Bowel Disease

Abstract

Background Inflammatory bowel disease (IBD) patients are at an increased risk of Clostridium difficile infection (CDI), but the impact of CDI on disease severity is unclear. The aim of this study was to determine the effect of CDI on long-term disease outcome in a matched cohort of IBD patients. Methods Patients who tested positive for infection formed the CDI positive group. We generated a 1:2 propensity matched case to control cohort based on risk factors of CDI in the year prior to infection. Healthcare utilization data (emergency department use, hospitalizations, telephone encounters), medications, labs, disease activity and quality of life (QOL) metrics were compared by CDI status. Results A total of 198 patients (66 CDI, 132 matched controls) were included (56.6% female; 60.1% Crohn’s disease, 39.9% ulcerative colitis). In the year of infection, having CDI was significantly associated with more steroid and antibiotic exposure, elevated C-reactive protein or erythrocyte sedimentation rate, low vitamin D, increased disease activity, worse QOL, and increased healthcare utilization (all p<0.01). During the next year after infection, CDI patients continued to have increased exposure to CDI targeted antibiotics (p<0.001) and other antibiotics (p=0.02). They also continued to have more clinic visits (p=0.02), telephone encounters (p=0.001), and increased healthcare financial charges (p=0.001). Conclusions CDI in IBD is significantly associated with markers of disease severity, increased healthcare utilization and poor QOL during the year of infection, and a five-fold increase in healthcare charges in the year following infection.

The Impact of Inflammatory Bowel Disease in Canada 2018: Extra-intestinal Diseases in IBD

“…In a study from the University of Pittsburgh, it was shown that during the year of a C. difficile infection, having a C. difficile infection was significantly associated with more corticosteroid and antibiotic exposure and increased disease activity, worse quality of life and increased health care utilization (all P < 0.01) (38). During the next year after a C. difficile infection, patients continued to have increased exposure to C. difficile infection-targeted antibiotics ( P < 0.001) and other antibiotics ( P = 0.02).…”

Effects of amygdalin on type II collagen-induced arthritis in rats

“…It has been reported that multiple cytokines and pro-inflammatory mediators from T cells and B cells, macrophages, synovial cells, as well as collagenases are involved in the initiation and development of the chronic inflammatory process in the RA synovial membrane (Granet and Miossec 2004). Synovial cells (macrophages and fibroblasts) present antigens to T cells, and then the activated T cells secrete multiple soluble mediators, including IL-1β and TNF-α (Anderson et al 2017). These mediators stimulate synovial hyperplasia and the production of collagenase and prostaglandin E2, which further aggravates the inflammatory response (Lin 2013).…”

Risk factors for Clostridioides difficile infection in children and adolescents with inflammatory bowel disease: a systematic review and meta-analysis

“…It is reported in more severe pediatric IBD there exist dysbiosis of intestinal bacterial flora, which may have an impact on reducing resistance to colonization and hence increased susceptibility to CDI [37]. Even so, it is difficult to ascertain the relationship between disease activity in IBD and CDI; as CDI could in turn increase disease activity of IBD [38]. These findings suggested CDI and disease activity in IBD may be positively correlated.…”