Temporal trends in disease outcomes related to Clostridium difficile infection in patients with inflammatory bowel disease

Ananthakrishnan, Ashwin N.; McGinley, Emily L.; Saeian, Kia; Binion, David G.

doi:10.1002/ibd.21457

Cited by 133 publications

(106 citation statements)

References 31 publications

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“…Similarly to the above mentioned single-center studies, several studies using nationwide data also reported increased CDI incidence in IBD patients (9,11,12,26). Nguyen et al (12) analyzed data from the National Inpatient Sample (NIS), a component of the Healthcare Cost and Utilization Project (HCUP) containing information on more than 90% of USA community hospital discharges, and found that over a 7-year period (1998-2004) CDI incidence among hospitalized IBD patients nearly doubled in those with UC (26.6/1,000 to 51.2/1,000) (2.7% to 5.1%).…”

Section: Introductionmentioning

confidence: 61%

“…Studies report variable results regarding length of hospital stay in IBD patients with concomitant CDI: some found similar stays (22,27), some shorter (10), while others reported longer stays than in IBD patients without CDI (8,9,12). Contrasting results have also been reported regarding colectomy and mortality rate in IBD patients with superimposed CDI (8,9,12,26). Ananthakrishnan et al (46) in an analysis of NIS database found that IBD patients with CDI had a six-fold higher risk of colectomy than those with IBD alone.…”

Section: Discussionmentioning

confidence: 99%

“…As in the general population, advanced age and comorbidities increase the risk for CDI in IBD patients (22,26). Although the proportion of older IBD patients has increased in recent years, a nationwide retrospective study found an average age of CDI in IBD cohorts significantly lower than in general population controls (9).…”

Section: Risk Factorsmentioning

confidence: 99%

“…CDI was first associated with IBD in the early 1980s (13), but was somehow neglected until ten years ago, when several studies and reviews clearly demonstrated that patients with one of the two major forms of IBD (ulcerative colitis-UC; Crohn's disease-CD) are at high-risk for CDI (8)(9)(10)(11)(12)(14)(15)(16)(17)(18)(19)(20)(21). Besides the well-known risk factors for CDI in non-IBD population, there are some typical IBD-related risk fac-EPIDEMIOLOGY Both single-center studies (8,9,22,27,(29)(30)(31) and large nationwide data analyses (9,11,12,26) have independently reported an increased CDI incidence among IBD patients.…”

Section: Introductionmentioning

confidence: 99%

“…Nguyen et al (12) analyzed data from the National Inpatient Sample (NIS), a component of the Healthcare Cost and Utilization Project (HCUP) containing information on more than 90% of USA community hospital discharges, and found that over a 7-year period (1998-2004) CDI incidence among hospitalized IBD patients nearly doubled in those with UC (26.6/1,000 to 51.2/1,000) (2.7% to 5.1%). Using data from NIS 200, Ananthakrishnan et al (26) found a continuing and significant increase in the frequency of CDI among all IBD hospitalizations nationwide (from 2.5% in 1998 to 5.3% in 2007 for UC, and from 0.8% in 1998 to 1.5% in 2007 for CD; p<0.01). Ricciardi et al (11) in a retrospective analysis of all IBD patients in the NIS from 1993-2003 found a significantly increased prevalence of CDI in patients with UC and colonic CD, but not in those with CD limited to the small bowel.…”

Section: Introductionmentioning

confidence: 99%

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Clostridium difficile infection and inflammatory bowel disease

Cojocariu

Stanciu

Stoica³

et al. 2020

Turk J Gastroenterol

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Over the past 15 years, Clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD) has increased both in incidence and severity. Traditional risk factors for CDI are similar in IBD and non-IBD populations, but there is a significant proportion of IBD patients which have distinctive characteristics. Patients with ulcerative colitis (UC) are more susceptible to CDI and have more severe outcomes than those with Crohn's disease (CD). CDI may be difficult to distinguish from an IBD flare due to similar clinical presentation, and therefore screening for CDI is recommended at every flare in such patients. Several studies showed worse clinical outcomes in IBD patients with CDI, including longer hospital stay, higher colectomy and mortality rates than in those without CDI. Vancomycin and metronidazole appear to have similar efficacy in patients with moderate disease, but vancomycin is preferred in severe disease. Measures must be taken to prevent the spread of infection. Clinicians should have a high index of suspicion for CDI when evaluating a patient with IBD flare, as rapid detection and prompt treatment of infection improve outcomes. This review summarizes the available literature on epidemiology, risk factors, clinical aspects, diagnostic methods, treatment, outcome, and prevention of CDI in IBD patients.

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Section: Introductionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Clostridium difficile infection and inflammatory bowel disease

Cojocariu

Stanciu

Stoica³

et al. 2020

Turk J Gastroenterol

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Crohn's Disease: Clinical Manifestations and Management

Melmed

Targan

2015

Yamada' S Textbook of Gastroenterology

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Systematic review and meta-analysis of outcomes following emergency surgery for Clostridium difficile colitis

Bhangu

Nepogodiev

Gupta

et al. 2012

British Journal of Surgery

141

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Background: Only a small proportion of patients with severe Clostridium difficile infection (CDI) undergo emergency surgery, the timing and nature of which is unclear. The aim of this study was to describe the operations performed and to identify factors predictive of death following emergency surgery for CDI.Methods: A systematic review of published literature was performed for studies comparing survivors and non-survivors of emergency surgery for CDI. Meta-analysis was carried out for 30-day and in-hospital mortality.Results: Overall 31 studies were included, which presented data on a total of 1433 patients undergoing emergency surgery for CDI. Some 1·1 per cent of all patients with CDI and 29·9 per cent with severe CDI underwent emergency surgery, although rates varied between studies (0·2-7·6 and 2·2-86 per cent respectively). The most commonly performed operation was total colectomy with end ileostomy (89·0 per cent, 1247 of 1401 detailed surgical procedures). When total colectomy with end ileostomy was not performed, reoperation to resect further bowel was needed in 15·9 per cent (20 of 126). Where described, the 30-day mortality rate was 41·3 per cent (160 of 387). Meta-analysis of highquality studies revealed that the strongest predictors of postoperative death were those relating to preoperative physiological status: preoperative intubation, acute renal failure, multiple organ failure and shock requiring vasopressors. Conclusion:This systematic review supports total colectomy with end ileostomy as the primary surgical treatment for patients with severe CDI; other surgical procedures are associated with high rates of reoperation and mortality. Less extensive surgery may have a role in selected patients with earlier-stage disease.

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Temporal trends in disease outcomes related to Clostridium difficile infection in patients with inflammatory bowel disease

Abstract: There has been a temporal increase nationwide in CDI complicating IBD hospitalizations. The excess morbidity associated with C. difficile infection in hospitalized IBD patients has increased between 1998 and 2007.

Cited by 133 publications

References 31 publications

Clostridium difficile infection and inflammatory bowel disease

Clostridium difficile infection and inflammatory bowel disease

Crohn's Disease: Clinical Manifestations and Management

Systematic review and meta-analysis of outcomes following emergency surgery for Clostridium difficile colitis

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