INCIDENCE AND RISK FACTORS OF CLOSTRIDIUM DIFFICILE INFECTION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Recent changes in the epidemiology of Clostridium difficile infection (CDI) include the identification of patients with inflammatory bowel disease (IBD) as a group at risk in comparison to the general population. Aim: To identify the incidence and risk factors for CDI among patients with IBD. Material and methods: Case-control study of 78 patients diagnosed with IBD, hospitalized at the Iasi Institute of Gastroenterology and Hepatology between January 2012 and -July 2014. Demographic data and clinical characteristics were reviewed for all patients. IBD patients with positive C. difficile toxins A and B tests were matched by sex, age and type of IBD with IBD patients hospitalized in the same period with negative C. difficile toxins tests. Results: Both groups were comparable for baseline characteristics. Of the 78 patients diagnosed with IBD included in the study, C. difficile was detected in 26 patients (33.33%). There was no statistical difference regarding length of hospital stay (10.42 +/- 7.34 vs. 8.01 +/- 6.14 days, p=0.129) between the two study groups. Risk factors for CDI in patients with IBD were: ulcerative colitis (OR=1.90, CI=1.320-2.720, p=0.001), use of proton pump inhibitors (OR=1.57, CI=1.133-2.032, p=0.012), previous antibiotic use (OR=2.3, CI=1.587-3.332, p<0.0001), and albumin<3g/dl (OR=1.78, CI=1.023-5.558, p=0.038). Immunosuppressive and anti TNF-alpha treatment were not risk factors for C. difficile development in patients with IBD. Conclusions: CDI in patients with IBD is a serious infection and should be treated aggressively with close clinical follow-up. Ulcerative colitis, previous treatment with antibiotics and proton pump inhibitors represent risk factors for CDI development in patients with IBD.