Clostridioides difficile infection increases the need for using biologics in patients with inflammatory bowel...

Inflammatory bowel disease (IBD), comprising Crohn's disease and ulcerative colitis, is characterized by chronic intestinal inflammation and may be complicated by gastrointestinal infections. Among these, Clostridioides difficile infection (CDI) is relevant because of its association with worse outcomes and increased therapeutic needs. We aimed to evaluate the prevalence of enteric infections during IBD flares and to assess the long-term impact of CDI on disease management and treatment escalation.

We retrospectively analyzed 102 IBD patients hospitalized for disease flares at a single tertiary care center between January 2020 and September 2024. All patients underwent stool testing for enteric pathogens. Clinical, laboratory, and treatment data were collected at baseline and 12 months.

Gastrointestinal infections were detected in 19% of patients; CDI accounted for 58% of these. At 12 months after gastrointestinal infection, advanced therapy use was more frequent in gastrointestinal infection positive (GI+) patients (63% vs. 43%; P = 0.04). CDI+ patients had a significant increase in biologic use over time. Gastrointestinal infection positivity was independently associated with biologic use at 12 months (odds ratio = 3.5, P = 0.02).

Recognizing gastrointestinal infection promptly and integrating infection history into therapeutic decision-making may improve patient outcomes by preventing severe disease progression and guiding timely escalation of therapy.