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Clostridium difficile infection in hospitalized patients with inflammatory bowel disease: Prevalence, risk factors, and prognosis.

Abstract To evaluate the frequency, possible risk factors, and outcome of Clostridium difficile infection (CDI) in inflammatory bowel disease (IBD) patients.There has been an upsurge of CDI in patients with IBD who has been associated with increased morbidity and mortality. Various risk factors have been found to predispose IBD patients to CDI.A retrospective case-control study on IBD patients admitted with exacerbation and tested for CDI at the Tel Aviv Medical Center in 2008 to 2013. Epidemiologic, laboratory, and prognostic data were retrieved from electronic files and compared between patients who tested positive (CDI+) or negative (CDI-) for CDI.CDI was identified in 28 of 311 (7.31%) IBD patients hospitalized with diarrhea. IBD-specific risk factors (univariate analysis) for CDI included: use of systemic steroids therapy (odds ratio [OR] = 3.6, 95% confidence interval [CI] 1.2-10.6) and combinations of ≥2 immunomodulator medications (OR = 2.6, 95% CI 1.1-6.3). Additional risk factors for CDI that are common in the general population were hospitalization in the preceding 2 months (OR = 6.0, 95% CI 2.6-14.1), use of antacids (OR = 3.8, 95% CI 1.7-8.4), and high Charlson comorbidity score (OR = 2.5, 95% CI 1.1-5.7). A multivariate analysis confirmed that only hospitalization within the preceding 2 months and use of antacids were significant risk factors for CDI. The prognosis of CDI+ patients was similar to that of CDI- patients.Hospitalized IBD patients with exacerbation treated with antacids or recently hospitalized are at increased risk for CDI and should be tested and empirically treated until confirmation or exclusion of the infection.
PMID
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Authors

Mayor MeshTerms

Clostridium difficile

Hospitalization

Keywords
Journal Title medicine
Publication Year Start




PMID- 29384868
OWN - NLM
STAT- MEDLINE
DCOM- 20180209
LR  - 20180209
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 5
DP  - 2018 Feb
TI  - Clostridium difficile infection in hospitalized patients with inflammatory bowel 
      disease: Prevalence, risk factors, and prognosis.
PG  - e9772
LID - 10.1097/MD.0000000000009772 [doi]
AB  - To evaluate the frequency, possible risk factors, and outcome of Clostridium
      difficile infection (CDI) in inflammatory bowel disease (IBD) patients.There has 
      been an upsurge of CDI in patients with IBD who has been associated with
      increased morbidity and mortality. Various risk factors have been found to
      predispose IBD patients to CDI.A retrospective case-control study on IBD patients
      admitted with exacerbation and tested for CDI at the Tel Aviv Medical Center in
      2008 to 2013. Epidemiologic, laboratory, and prognostic data were retrieved from 
      electronic files and compared between patients who tested positive (CDI+) or
      negative (CDI-) for CDI.CDI was identified in 28 of 311 (7.31%) IBD patients
      hospitalized with diarrhea. IBD-specific risk factors (univariate analysis) for
      CDI included: use of systemic steroids therapy (odds ratio [OR] = 3.6, 95%
      confidence interval [CI] 1.2-10.6) and combinations of >/=2 immunomodulator
      medications (OR = 2.6, 95% CI 1.1-6.3). Additional risk factors for CDI that are 
      common in the general population were hospitalization in the preceding 2 months
      (OR = 6.0, 95% CI 2.6-14.1), use of antacids (OR = 3.8, 95% CI 1.7-8.4), and high
      Charlson comorbidity score (OR = 2.5, 95% CI 1.1-5.7). A multivariate analysis
      confirmed that only hospitalization within the preceding 2 months and use of
      antacids were significant risk factors for CDI. The prognosis of CDI+ patients
      was similar to that of CDI- patients.Hospitalized IBD patients with exacerbation 
      treated with antacids or recently hospitalized are at increased risk for CDI and 
      should be tested and empirically treated until confirmation or exclusion of the
      infection.
FAU - Maharshak, Nitsan
AU  - Maharshak N
AD  - Department of Gastroenterology and Liver Diseases, Tel-Aviv Medical Center,
      Affiliated to the Sackler Faculty of Medicine, Tel Aviv University.
FAU - Barzilay, Idan
AU  - Barzilay I
AD  - Department of Gastroenterology and Liver Diseases, Tel-Aviv Medical Center,
      Affiliated to the Sackler Faculty of Medicine, Tel Aviv University.
FAU - Zinger, Hasya
AU  - Zinger H
AD  - Department of Gastroenterology and Liver Diseases, Tel-Aviv Medical Center,
      Affiliated to the Sackler Faculty of Medicine, Tel Aviv University.
FAU - Hod, Keren
AU  - Hod K
AD  - Department of Epidemiology and Preventive Medicine, School of Public Health,
      Sackler Faculty of Medicine, Tel Aviv University.
AD  - Research Division, Epidemiology Service, Assuta Medical Centers.
FAU - Dotan, Iris
AU  - Dotan I
AD  - Department of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petah
      Tikva, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel
      Aviv, Israel.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Immunologic Factors)
SB  - AIM
SB  - IM
MH  - Adult
MH  - Clostridium Infections/*diagnosis/*etiology/therapy
MH  - *Clostridium difficile
MH  - Female
MH  - *Hospitalization
MH  - Humans
MH  - Immunologic Factors/therapeutic use
MH  - Inflammatory Bowel Diseases/*complications/diagnosis/therapy
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Retrospective Studies
MH  - Risk Factors
EDAT- 2018/02/01 06:00
MHDA- 2018/02/10 06:00
CRDT- 2018/02/01 06:00
PHST- 2018/02/01 06:00 [entrez]
PHST- 2018/02/01 06:00 [pubmed]
PHST- 2018/02/10 06:00 [medline]
AID - 10.1097/MD.0000000000009772 [doi]
AID - 00005792-201802020-00030 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Feb;97(5):e9772. doi: 10.1097/MD.0000000000009772.