Molecular Epidemiology And Clinical Analysis Of Clostridium Difficile Infection In Inflammatory Bowel Disease

BackgroundOver the past two decades,the incidence and severity of Clostridium difficile infection(CDI)has been increasing significantly.In America,the status of C.difficile has exceeded methicillin-resistant Staphylococcus aureus(MRSA)and has become the major cause of nosocomial infection.Currently,no outbreaks caused by hypervirulent strains have been reported in China,but NAP1/RT027 strains have been isolated from patients' feces in Guangdong and Beijing according to few studies.Inflammatory bowel disease(IBD)is a kind of chronic nonspecific inflammatory bowel disease and has lifetime recurrence tendency.The incidence of IBD in China has been increasing in the past decades,and it has become a common cause of digestive system diseases including chronic diarrhea.Presently,most studies found that IBD is an independent risk factor for CDI.At the same time,CDI can lead the outcome of IBD patients to be worse,e.g.increasing the mortality rate and extending the length of stay.ObjectiveTo investigate the molecular epidemiology of CDI in IBD patients and to find out the risk factors of CDI among patients with IBD.MethodsAccording to the inclusion and exclusion criteria,patients with IBD admitted to the First Affiliated Hospital with Nanjing Medical University(Jiangsu Province Hospital)from August 2013 to December 2018 were enrolled.IBD patients werematched with non IBD patients according to age and gender.Diarrhea samples were sent for C.difficile isolation.Toxin genes,tcdA,tcdB,cdtA and cdtB,were also detected.At the same time,the molecular epidemiology investigation of related strains was performed by MLST method.Finally,patients' information was collected and logistic regression analysis was performed to analyze the risk factors of CDI among patients with IBD.ResultsIn this study,the incidence of CDI in IBD patients was much higher than that in non IBD patients(24.6% vs.9.0%)and community acquired infection was the main kind.The molecular epidemiology of CDI in this study was mainly ST54.The early onset of IBD(the first year after diagnosis of IBD)and recent use of quinolone antibiotics were independent risk factors of CDI in IBD patients.ConclusionAlthough no hypervirulent strain was detected in this study,the incidence of CDI in IBD patients in our hospital was higher than that in most western countries.In addition,if the history of IBD is within one year or quinolone antibiotics have been used recently,clinicians should consider the possibility of IBD patients complicated with CDI and adjust the treatment plan.