The impact of Clostridum difficile on surgical rate among ulcerative colitis patients: A systemic review and meta-analysis

Abstract

There is growing recognition of the impact of Clostridum difficile infection (CDI) on patients with inflammatory bowel disease. Clostridium difficile infection causes greater morbidity and mortality. This study aimed to evaluate the impact of C. difficile on surgical risk among ulcerative colitis (UC) patients. We searched the following databases: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, ACP Journal Club, DARE, CMR, and HTA. Studies were included if fulfilled the following criteria: (1) Cohort or case–control studies, which involved a comparison group that lacked CDI, (2) Patients were given a primary diagnosis of UC, (3) Comorbidity of CDI was evaluated by enzyme immunoassay of stool for C. difficile toxin A and B or C. difficile stool culture, (4) Studies evaluated surgical rate, and (5) Studies reported an estimate of odds ratio, accompanied by a corresponding measure of uncertainty. Five studies with 2380 patients fulfilled the inclusion criteria. Overall, meta-analysis showed that UC with CDI patients had a significant higher surgical rate than patients with UC alone. (OR=1.76, 95% CI=1.36–2.28). C. difficile infection increased the surgical rate in UC patients. However, results should be interpreted with caution, given the limitations of this stud.

Clostridium difficile infection in hospitalized patients with inflammatory bowel disease

“…Diagnosing and treating CDI in the IBD population is challenging due to the similar clinical and endoscopic presentations of IBD flare and CDI. [ 38 ] Current evidence indicates that CDI in IBD patients is associated with worse outcomes, as reflected by the need for colectomy, [ 39 , 40 ] escalation of treatment, recurrent hospitalizations, [ 15 ] a prominent increase in recurrent infection rates, [ 41 – 43 ] and a higher mortality rate, [ 33 , 44 ] all of which warrant further evaluation of the prevalence, potential risk factors, and impact of CDI on IBD patients’ outcome.…”

The Current Knowledge on Clostridioides difficile Infection in Patients with Inflammatory Bowel Diseases

“…In a systematic review and meta-analysis, a significant higher risk of surgery was found in UC-CDI patients, compared with UC-alone patients (OR = 1.76, 95% CI = 1.36–2.28), although the severity of underlying IBD and associated comorbidities, that could influence the poor outcomes, had not been assessed [ 116 ]. Preoperative C. difficile colitis was associated with pouch failure in a study performed by Skowron et al [ 117 ].…”

Intestinal Microbiota and Perspectives of the Use of Meta-Analysis for Comparison of Ulcerative Colitis Studies

“…In a 2015 study “The impact of Clostridium difficile on surgical rate among ulcerative colitis patients: a systematic review and meta-analysis”, the authors evaluated the association between Clostridium difficile infection and the rate of colectomy in patients with UC. Statistical analysis was performed using RevMan X6 software (from Cochrane Collaboration) [ 108 ].…”

“…There was no statistically significant heterogeneity among the included studies ( p = 0.09). However, the number of studies included was small, so the result should be interpreted with caution [ 108 ].…”