A Prospective Study On Clostridium Difficile Infection Among Patients With Inflammatory Bowel Disease

Objective:The incidence of Clostridium difficile infection (CDI) in inflammatory bowel disease (IBD) is increasing, and CDI has a negative impact on IBD outcomes with both increased morbidity and mortality. Data are lacking regarding the incidence rate about CDI in Chinese IBD patients. This study sought to determine the rate of CDI positivity among newly diagnosed IBD patients in our hospital, identify its risk factors and clinical characteristics, and assess outcome of IBD in patients following CDI.Methods:A one year prospective study on new admissions with IBD was conducted in Sir Run Run Shaw hospital from March 2014 to March 2015, the patients were monitored in strict accordance with case inclusion and exclusion criteria. Stool samples were obtained from patients within 24 hours of admission and cultured for anaerobic. Strains isolated were confirmed to be Clostridium difficile besed on the typical odor, appearance of colonies and microscopic morphology with Gram stain. In addition, polymerase chain reaction(PCR) was done to confirm the presence of Tcd(Toxins of Clostridium difficile)A and tc<B. IBD with CDI(CDI+) and IBD without CDI(CDI-) were grouped on a varity of factros. Numeric variables were analysed by t-tests and Wilcoxon’s tests(for symmetric and asymmetric data, respectively). Categorical variables were analysed by Chi-square test.Results:Of 216 enrolled IBD patients, there were 73 Ulcerative Colitis(UC) patients and 143 Crohn’s Disease(CD) patients. A total of 30 patients were diagnosed with CDI, of whom 18 were UC patients and 12 were CD patients. The incidence rate of CDI were 13.89% in IBD patients,24.66% in UC patients and 8.39% in CD patients. UC patients had higher incidence rate of CDI than CD patients, a statistically significant difference(x2=10.691, P<0.001).Among the 30 severely active UC patients, eleven(11/30,36.67%) cases developed CDI. Among the 23 moderately active UC patients, five(5/23,21.74%) cases developed CDI. Among the 17 mildly active UC patients, two(2/17,11.76%) cases developed CDI. None of the three UC patients in remisson developed CDI. The severity was the risk factor for UC with CDI(x2=4.816, P=0.028).Six cases(6/18) with UC and CDI had received antibiotics during the previous one month versus 11(11/55)cases in the control group(UC without CDI,P=0.401). One cases(1/12) with CD and CDI had received antibiotics during the previous one month versus 37(37/131)cases in the control group(CD without CDI,P=0.249). Antibiotic exposure within 30 days prior to Clostridium difficile testing was not associated with an increased risk for CDI,Seven(7/18)cases with UC and CDI received treatment with proton pump inhibitor(PPI) versus four(4/55) in the control group(UC without CDI)(P=0.004). The use of PPI within 30 days prior to Clostridium difficile testing was associated with an increased risk for CDI.Length of stay was similar among CD patients with CDI and CD without CDI(P=0.352). Compared with UC without CDI, CDI patients were more likely to have a prolonged hospitalization(P=0.005).Subsequent colectomy within 3 months after CDI diagnosis, was not associated with CDI in UC patients(P=0.313). However, five(5/12) cases with CD and CDI required colectomy within three months versus 14(14/131) cases in the control group(CD without CDI)(P=0.01). There was no IBD-or CDI-associated mortality in this study.Conclusion:The incidence rate of CDI in IBD patients were relatively high, and the prevalence of CDI among UC patients was higher than that among CD patients. The severity was the risk factor for UC with CDI. Compared with UC patients without CDI, CDI patients were more likely to have a history of previous hospitalization and PPIs. The use of antibiotics, aminosalicylic acid and glucocorticoid in IBD does not influence the risk. UC patients had longer hospital stay than those without CDI. CD patients had higher colectomy rate within 3 months after CDI diagnosis than those without CDI. Increased vigilance regarding this infection in IBD patients with colitis activity is warranted.