Issue 02

Clinical Question

What is the current epidemiologic profile of Clostridium difficile infection (CDI) in IBD versus non-IBD patients in Canada?

Editor’s Bottom Line

Patients with IBD face an increased risk of CDI, but less CDI-associated mortality than patients without IBD.

Reference

Singh H, Nugent Z, Yu BN, et al. Higher Incidence of Clostridium difficile infection among individuals with inflammatory bowel disease. Gastroenterology. 2017 Aug;153(2):430–38.e2. https://www.ncbi.nlm.nih.gov/pubmed/28479377

Synopsis

Five linked databases managed by Manitoba Health and the University of Manitoba IBD Epidemiology Database were used to identify the cohort, out of a total population of ~1.3 million, who had laboratory confirmed CDIs from July 2005 to March 2014. Infected IBD cases were matched with non-IBD controls. Details noted were the site of CDI infection (healthcare facility and community onset or associated or indeterminate); if the CDI was recurrent or incident; and if it was severe or not. As part of the risk factor analyses, socioeconomic factors and comorbidities were identified.

The final CDI cohort (n=576) comprised 191 IBD patients (CD, n=84; UC, n=107) matched with 385 non-IBD patients and experienced a total of 809 episodes of CDI. Patients with IBD had a 4.8 times increased risk for CDI than non-IBD controls; this increase was similar between CD and UC. No significant changes in incidence of CDI in patients with IBD were noted over time, while the highest CDIs were found in the first year after diagnosis of IBD. Risk of recurrent CDI after the initial episode was similar between IBD and non-IBD and CD versus UC. Community-onset CDI was more common in IBD versus non-IBD patients. Factors associated with increased risk for developing CDI in IBD patients included: corticosteroids, biologics, metronidazole, hospitalizations, high number of ambulatory care visits, shorter IBD duration, and greater number of morbidities. Mortality rates were lower in patients with IBD compared to non-IBD controls.

Details

Study Design: Retrospective population-based study
Funding: American College of Gastroenterology
Allocation: n/a
Setting: Manitoba
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.