People with inflammatory bowel disease (IBD) are at increased risk of experiencing recurrent Clostridium difficile infection (CDI), according to a new study.
“In addition to finding that IBD patients had higher rates of recurrent C. difficile infection than non-IBD patients, we also found that these recurrent infections often occurred well beyond 6 months,” Dr. Geoffrey C. Nguyen from the University of Toronto, Ontario, Canada, told Reuters Health by email.
“This is in contrast to non-IBD patients who experienced recurrent CDI within the first 6 months. I think this is an indication that IBD patients have ongoing risk factors related to their disease or its treatment,” he said.
CDI is twice as common among hospitalized IBD patients and is associated with more than triple hospital mortality rates compared with non-IBD patients. Recurrent CDI remains a significant challenge for IBD patients, Dr. Nguyen and colleagues note in The American Journal of Gastroenterology, online May 24.
The team investigated the incidence of recurrent CDI among 503 patients with CDI, 110 (22%) of whom were IBD patients.
During more than 13,000 person-months of follow-up, nearly a third of IBD patients (31.8%) experienced recurrent CDI, compared to 23.9% of non-IBD patients (p<0.01).
The incidence of recurrent CDI was 2.04 episodes per 100 person-months for IBD patients, compared with 1.25 episodes per 100 person-months for non-IBD patients (p<0.001).
The mean time to first recurrence of CDI was significantly shorter in the non-IBD group (76 days) than among patients with IBD (157 days).
IBD patients were more likely than non-IBD patients to require colectomy after CDI (6.4% vs. 0.3%, p<0.001). There were no CDI-attributable deaths among IBD patients, but 12.2% of non-IBD patients died because of CDI.
Compared with IBD patients who had only a single episode of CDI, IBD patients with recurrent CDI were significantly more likely to report recent antibiotic therapy, 5-aminosalicylic acid (5-ASA) use, steroid use, and biologic therapy.
Significant independent predictors of recurrent CDI in IBD patients included non-ileal Crohn’s disease and the use of 5-ASA.
Compared with non-IBD patients, IBD patients were 48% less likely to have a recurrence within six months, but 4.88-fold more likely to experience one after six months.
“The predisposing factors for CDI and recurrent CDI are likely different for those with IBD than those without,” Dr. Nguyen said. “We need to further understand these risk factors in order to reduce the burden of CDI in the IBD population.”
“I think physicians need to remain vigilant for recurrent CDI in IBD patients even years after the initial infection,” Dr. Nguyen concluded. “So we need to continue to test for C. difficile during diarrhea-predominant IBD flares.”
Dr. David G. Binion, director of translational IBD research at the University of Pittsburgh School of Medicine, told Reuters Health by email that “Much of the morbidity and mortality related to C. difficile stems from recurrent infection.”
“The paper is very interesting and important and sheds new light on the challenge of C. difficile infection in patients with IBD,” said Dr. Binion, who was not involved in the study.