Recurrent Clostridium difficile infection ( rCDI ) contributes to a significant burden of disease in patients with inflammatory bowel disease ( IBD ).
In the RECIDIVISM study, researchers have sought to identify risk factors for recurrent Clostridium difficile infection in a population of IBD patients at the Mount Sinai Hospital IBD Centre.
In this retrospective cohort study, IBD patients with recurrent Clostridium difficile infection diagnosed between 2010 and 2013 were identified and compared with IBD patients with single-episode Clostridium difficile infection.
Outcome analysis was performed for hospitalizations due to Clostridium difficile infection, colectomy, and CDI-attributable mortality.
A total of 503 patients were included, 110 ( 22% ) of whom had IBD ( 49% Clostridium difficile infection, 51% ulcerative colitis ).
Recurrent Clostridium difficile infection occurred in 32% of IBD patients compared with 24% of non-IBD patients ( P less than 0.01 ).
IBD patients with recurrent Clostridium difficile infection were more likely than those without recurrent Clostridium difficile infection to report recent antibiotic therapy ( 42.9 vs. 30.7%, P less than 0.01 ), 5-Aminosalicylic acid ( 5-ASA ) use ( 51.5 vs. 30.7%, P less than 0.001 ), steroid use ( 51.4 vs. 33.3%, P less than 0.001 ), and biologic therapy ( 48.6 vs. 40.0%, P less than 0.01 ).
Infliximab [ Remicade ] ( 34.3 vs. 17.3%, P less than 0.01 ) but not Adalimumab [ Humira ] was associated with more recurrent Clostridium difficile infection events.
Using a Cox model of predictors of recurrent Clostridium difficile infection in IBD, significant predictors included non-ileal Crohn’s disease ( hazard ratio, HR=2.85, 95% confidence interval ( CI ) 1.30–6.30 ) and the use of 5-ASA ( HR=2.15, 95% CI 1.11–4.18 ).
In conclusion, compared with the general population, IBD patients are 33% more likely to experience recurrent Clostridium difficile infection.
Within the IBD cohort, exposure to certain drug classes ( antibiotics, 5-ASA, steroids, certain biologics ) and non-ileal Crohn’s disease were found to be the predictors of recurrent Clostridium difficile infection. ( Xagena )
Razik R et al, Am J Gastroenterol 2016| doi:10.1038/ajg.2016.187