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A Protocol to Characterize the Morphological Changes of Clostridium difficile in Response to Antibiotic Treatment
Published on: May 25, 2017
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Clostridium difficile in inflammatory bowel disease
O V Knyazev1, A V Kagramanova1, M E Chernova1
1A.S. Loginov Moscow Сlinical Scientific Сenter, Moscow, Russia.
Terapevticheskii Arkhiv
|February 1, 2019
Summary
Clostridium difficile infection (CDI) affects 17.3% of inflammatory bowel disease (IBD) patients, often at a younger age and without typical risk factors like antibiotic use. Immunosuppressants increase CDI risk in IBD patients, while salicylates are less effective for those with CDI.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Epidemiology
Background:
- Inflammatory bowel disease (IBD) encompasses Crohn's disease (CD) and ulcerative colitis (UC).
- Clostridium difficile infection (CDI) is a significant concern in IBD patients, potentially altering disease course and treatment strategies.
- Understanding the epidemiology and risk factors for CDI in IBD is crucial for effective management.
Purpose of the Study:
- To investigate the incidence and epidemiological characteristics of CDI in patients diagnosed with IBD.
- To identify specific risk factors associated with the development of CDI in this patient population.
- To compare CDI prevalence and risk factors between Crohn's disease and ulcerative colitis patients.
Main Methods:
- A retrospective analysis of 1179 medical records of IBD patients was conducted.
- 764 patients meeting inclusion criteria were divided into groups with and without a preliminary CDI diagnosis.
- Statistical analyses included Pearson Chi-square and two-sample t-tests to compare groups.
Main Results:
- The incidence of CDI among IBD patients was 17.3%, with similar prevalence in CD (40.1%) and UC (59.9%) cohorts.
- CDI occurred at a mean age of 37.8 years, with 84.8% being community-acquired and only 4.5% hospital-associated.
- Long-term immunosuppressive therapy (azathioprine/6-mercaptopurine) was significantly associated with CDI in IBD patients (45.5% vs. 17.7%, p<0.001).
- Salicylate therapy was less effective in controlling CDI in IBD patients (18% remission) compared to those without CDI (62% remission, p<0.05).
Conclusions:
- CDI prevalence is comparable between UC and CD patients.
- IBD patients are susceptible to CDI at a younger age, independent of traditional risk factors like recent hospitalization or antibiotic use.
- IBD patients with CDI often show reduced response to salicylates, necessitating advanced therapies like biologics, and present with lower albumin levels and higher inflammatory activity.
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