Inflammatory bowel disease linked to poorer outcome from C. difficile infection

Last Updated: 2008-03-11 17:00:46 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Clostridium difficile infection in hospitalized patients is associated with greater morbidity and mortality in those with inflammatory bowel disease (IBD) than in patients without IBD, according to a report in the February issue of Gut.

"In the present day, it is essential that all IBD flares be evaluated for possible C. difficile infection," Dr. David G. Binion told Reuters Health. "IBD patients have significantly worse clinical outcomes from C. difficile infection, including increased rates of colectomy and mortality."

Dr. Binion and colleagues from the Medical College of Wisconsin, Milwaukee, evaluated excess morbidity and mortality in patients with C. difficile and IBD (n = 2804), compared with C. difficile alone (n = 44,400) or IBD alone (n = 77,366).

Compared with patients hospitalized with IBD alone, those who also had C. difficile experienced a longer hospital stay, higher hospitalization costs, and higher rates of lower GI endoscopy, the authors report.

Mortality was significantly higher among patients with C. difficile and IBD (4.2%) or C. difficile alone (3.7%) than among patients with IBD alone (0.5%), the report indicates.

"On multivariate analysis, patients in the C. difficile-IBD group had four times greater mortality than patients admitted to hospital for IBD alone (adjusted odds ratio = 4.7) or C. difficile alone (adjusted OR = 2.2), the investigators found.

The proportion of hospitalizations complicated by C. difficile infection increased significantly between 1998 and 2004 for both ulcerative colitis and Crohn's disease.

"C. difficile has doubled in North America in the past 5 years, and the IBD patient population has been affected at a disproportionately higher rate," Dr. Binion explained. "All physicians caring for IBD patients must be aware that deterioration in a previously stable patient must be evaluated for this infection, as empiric steroids may lead to deterioration."

"We have been evaluating whether the BI/NAP1 epidemic strain of C. difficile is associated with IBD patients," Dr. Binion added. "We continue to monitor rates of infection, which have plateaued at our institution after a significant increase detected in 2005."

"We will use standard protocols emphasizing metronidazole for IBD outpatients with C. difficile," Dr. Binion said. "For hospitalized IBD patients with C. difficile we will typically use oral vancomycin, which is more effective and has helped us lower the colectomy rate seen in this cohort."

Gut 2008;57:205-210.