Management of Clostridioides difficile infection in patients with inflammatory bowel disease

Khanna, Sahil

doi:10.5217/ir.2020.00045

Cited by 27 publications

(30 citation statements)

References 73 publications

(168 reference statements)

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“…In future studies, this may provide insight into which UC patients have a gut microbiome conducive to CDI and therefore have an increased risk of developing CDI. Identifying UC patients most at risk for developing CDI may be helpful to clinicians so that strategies to minimise future infection can be implemented 17,18 . CDI is a major cause of morbidity and mortality in UC patients and has been shown to be associated with an increased risk of colectomy, post‐operative complications and death 19‐23 .…”

Section: Discussionmentioning

confidence: 99%

Decreased secondary faecal bile acids in children with ulcerative colitis and Clostridioides difficile infection

Rotondo-Trivette

Wang

Gayer

et al. 2021

Aliment Pharmacol Ther

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Summary Background Patients with ulcerative colitis (UC) have an increased risk of Clostridioides difficile infection (CDI). There is a well‐documented relationship between bile acids and CDI. Aims To evaluate faecal bile acid profiles and gut microbial changes associated with CDI in children with UC. Methods This study was conducted at Children's Hospital Los Angeles. Faecal bile acids and gut microbial genes related to bile acid metabolism were measured in 29 healthy children, 23 children with mild to moderate UC without prior CDI (UC group), 16 children with mild to moderate UC with prior CDI (UC+CDI group) and 10 children without UC with prior CDI (CDI group). Results Secondary faecal bile acids, especially lithocholic acid (3.296 vs 10.793, P ≤ 0.001) and ursodeoxycholic acid (7.414 vs 10.617, P ≤ 0.0001), were significantly lower in children with UC+CDI when compared to UC alone. Secondary faecal bile acids can predict disease status between these groups with 84.6% accuracy. Additionally, gut microbial genes coding for bile salt hydrolase, 7α‐hydroxysteroid dehydrogenase and 7α/β‐dehydroxylation were all diminished in children with UC+CDI compared to children with UC alone. Conclusions Bile acids can distinguish between children with UC based on their prior CDI status. Bile acid profile changes can be explained by gut microbial genes encoding for bile salt hydrolase, 7α‐hydroxysteroid dehydrogenase and 7α/β‐dehydroxylation. Bile acid profiles may be helpful as biomarkers to identify UC children who have had CDI and may serve as future therapeutic targets.

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Section: Discussionmentioning

confidence: 99%

Decreased secondary faecal bile acids in children with ulcerative colitis and Clostridioides difficile infection

Rotondo-Trivette

Wang

Gayer

et al. 2021

Aliment Pharmacol Ther

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“…Traditionally, exposure to antibiotics, immunosuppression, acid reduction therapy, and hospitalization were considered as major risk factors for CDI in IBD patients [39]. Antibiotics may destroy the normal gastrointestinal flora, resulting in reduced colonization resistance sufficiently to allow toxin-producing strains of C. difficile to become pathogenic.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Background Risk factors and consequences associated with Clostridioides difficile infection (CDI) in children and adolescents with inflammatory bowel disease (IBD) are still uncertain. We conduct a systematic review and meta-analysis to assess risk factors and outcomes associated with CDI in children and adolescents with IBD. Methods PubMed, EMBASE and Cochrane Library databases were searched from inception to 24th February, 2021. Studies investigating risk factors, bowel surgery rate in pediatric IBD patients with and without CDI were included. Random-effects model was used for calculating summary estimates. Newcastle-Ottawa scale (NOS) was used for quality assessment. Results Fourteen studies, comprising 17,114 patients, were included. There was a significant association between 5-aminosalicylic acid (5-ASA) use and CDI [odds ratio (OR) = 1.95, 95% confidence interval (CI) 1.26-3.03], with minimal heterogeneity (I 2 = 0.00%). Increased risk of active disease (OR = 4.66, 95% CI 2.16-10.07) were associated with CDI in those studies performed in high quality score (NOS > 6) and significantly higher CDI rates in studies conducted outside USA (OR = 2.94, 95% CI 1.57-5.58). The bowel surgery rate in IBD with CDI was 3.8-57.1%, compared to that in IBD without CDI (0-21.3%). All studies were of moderate to high quality. Conclusions 5-ASA use and active disease might be risk factors associated with CDI in children and adolescents with IBD. Bowel surgery rates associated with CDI in IBD patients varied greatly. Large-scale clinical studies on CDI in children and adolescents with IBD are still needed to verify risk factors and outcomes.

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“… 11 , 12 For instance, Clostridium difficile can induce goblet cells and dendritic cells (DCs) to secrete TGF-β and IL-10, thereby generating ample signals to elevate the Treg population. 13 Moreover, Bacteroides fragilis can induce the population of Treg population and promote the levels of anti-inflammatory cytokines to against colitis. 14 , 15 In addition, gut microbiota can produce essential components, such as vitamin K, and short-chain fatty acids (SCFAs), and interfere with the invaded pathogens by competing for space and nutrients.…”

Section: Intestinal Immune Systemmentioning

confidence: 99%

Immunology of Inflammatory Bowel Disease: Molecular Mechanisms and Therapeutics

Lu¹,

MF²,

Liang³

et al. 2022

JIR

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As a main digestive organ and an important immune organ, the intestine plays a vital role in resisting the invasion of potential pathogens into the body. Intestinal immune dysfunction remains important pathogenesis of inflammatory bowel disease (IBD). In this review, we explained the interactions among symbiotic flora, intestinal epithelial cells, and the immune system, clarified the operating mechanism of the intestinal immune system, and highlighted the immunological pathogenesis of IBD, with a focus on the development of immunotherapy for IBD. In addition, intestinal fibrosis is a significant complication in patients with long-term IBD, and we reviewed the immunological pathogenesis involved in the development of intestinal fibrogenesis and provided novel antifibrotic immunotherapies for IBD.

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Management of Clostridioides difficile infection in patients with inflammatory bowel disease

Cited by 27 publications

References 73 publications

Decreased secondary faecal bile acids in children with ulcerative colitis and Clostridioides difficile infection

Decreased secondary faecal bile acids in children with ulcerative colitis and Clostridioides difficile infection

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

Immunology of Inflammatory Bowel Disease: Molecular Mechanisms and Therapeutics

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