Prevalence of Clostridioides difficile Infection After Ileal Pouch-anal Anastomosis in Patients With Chronic Antibiotic-dependent Pouchitis and Crohn’s-like Disease of the Pouch

Abstract

Background Recurrent or chronic antibiotic therapy is a therapeutic hallmark of chronic antibiotic-dependent pouchitis (CADP) or Crohn’s-like disease of the pouch. Antibiotics alter the gut microbiome, which may increase the risk of Clostridioides difficile infection (CDI). The aim of this study was to determine the prevalence of CDI in patients with CADP and Crohn’s-like disease of the pouch. Methods We conducted a retrospective cohort study of patients with CADP or Crohn’s-like disease of the pouch at a tertiary academic medical center. The primary outcome was prevalence of CDI. Secondary outcomes included antibiotic therapy at the time of CDI diagnosis, treatment regimens for CDI, and subsequent outcomes. Results Overall, 18 of 198 (9.1%) included patients developed CDI. Treatment with antibiotics at the time of CDI diagnosis occurred in 7 of 18 (39%) patients. Preoperative history of CDI was significantly associated with increased risk of developing CDI following ileal pouch anal anastomosis (IPAA) compared with those with no prior history of CDI (12 of 18 [67%] vs 11 of 180 [6%]; P < .001). In 16 of 18 (89%) patients, CDI treatment was initiated with predominantly oral vancomycin (72%) or metronidazole (17%). Conclusion Although chronic inflammatory conditions of the pouch arise postoperatively, the prevalence of CDI in this population appears to be similar compared with the general population of patients with inflammatory bowel disease prior to and post IPAA. Preoperative CDI appears to be the greatest risk for postoperative CDI and may require extra vigilance in the assessment of CDI after IPAA.

Classification and Management of Disorders of the J Pouch

“…A study based on administrative data from hospitalized patients with IBD with pouchitis found that the frequency of CDI was 2.6% in admitted patients (41). In addition, the prevalence of CDI in a retrospective cohort of 198 patients with CADP and CLDP was 9.1%, which is comparable with the general IBD population (42). Patients with CDI of the pouch might exhibit more systemic symptoms and higher recurrence rates than non-IPAA patients.…”

Management of Primary Sclerosing Cholangitis and Extraintestinal Disorders in Patients with Ileal Pouches: A Systemic Review

“…[44][45][46][47] Oral vancomycin has also been used to treat Clostridium difficile-associated pouchitis. 48,49 In a small case series of 41 patients with chronic pouchitis (3 with concurrent PSC) treated with 4 weeks of vancomycin, 21 patients (51%) demonstrated a clinical response, and at 3 and 6 months, 16 of the 21 responders (76%) demonstrated continued response and remained on chronic vancomycin therapy. 50 The therapeutic impact on liver function and inflammation of the prepouch ileum and pouch body treated by oral vancomycin has also been reported.…”