Recurrent C. difficile infection more common in IBD patients, increases risk for colectomy

WASHINGTON — Patients with inflammatory bowel disease have increased risk for recurrent Clostridium difficile infection compared with the general population, and those infected had a significantly increased risk for colectomy, according to data presented at Digestive Disease Week.

“We tried to identify risk factors for recurrent C. diff in IBD and then of course try to create a scoring model that would allow us to predict which patients had an elevated risk and therefore allow for early intervention,” Roshan Razik, MD, from Mount Sinai Hospital in Toronto, Canada, said in a presentation.

In the RECIDIVISM study, Razik and colleagues performed a retrospective chart review of records from a C. difficile infection database from 2010-2013, and used a case-control design to compare IBD patients with recurrent C. difficile infection to controls with IBD and only a single episode of C. difficile infection. They then used a retrospective cohort design to determine the incidence of recurrent C. difficile infection in IBD patients compared with non-IBD patients, and they identified predictors of recurrent infection in IBD patients using multivariate regression analysis.

Of 503 C. difficile-positive patients, 22% had IBD (49% Crohn’s disease; 51% ulcerative colitis). IBD patients with C. difficile infection were younger than non-IBD patients (mean age, 39 vs. 64 years; P < .001), and they were more likely to use steroids (39.1% vs. 12%; P < .001) and immunosuppressants (42.7% vs. 13.2%; P < .001), and to have had a prior bowel resection (28.2% vs. 11.5%; P < .001). Among the IBD patients, 32% had recurrent C. difficile infection vs. 24% of non-IBD patients (P < .01), and 6.4% underwent colectomy vs. 0.3% (P < .001). The most significant predictors of recurrent infection in IBD patients were recent antibiotic therapy, use of 5-ASAs, steroids, immunosuppresants and recent hospitalization (all P < .01).

“IBD patients in our study were 33% more likely to experience recurrent C. diff than the general population,” Razik said. “And IBD patients with even just a single episode of C. diff had a 20-fold higher risk of colectomy.” – by Adam Leitenberger

For more information:

Razik R, et al. Abstract 594. Presented at: Digestive Disease Week; May 16-19, 2015; Washington, D.C.

Disclosure: Razik reports no relevant financial disclosures. Please see the DDW faculty disclosure index for all other researchers’ relevant financial disclosures.

Editor's note: This article was updated on May 28, 2015, with additional information.