Patients with IBD Face a Higher Risk of C. difficile Infection

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People with inflammatory bowel disease (IBD) may be at a higher risk for Clostridioides difficile (C. diff) infection, which can worsen their symptoms and lead to complications.

Gastrointestinal infections, including C. diff, are responsible for approximately 10% of disease flares in patients with IBD. C. diff has been shown to complicate the course of IBD, lead to flares and cause treatment failure for those in remission, and it can increase the need for surgery and even raise mortality rates. Further, the risk of C. diff infection among patients with IBD is nearly five-fold compared with the general population.

“IBD patients with C. diff pose a clinical challenge in getting correctly diagnosed due to presenting with symptoms similar to an IBD flare and C. diff,” wrote a team of investigators from the HUS Helsinki University Hospital and Helsinki University in Finland. “These two conditions require distinctly different treatment approaches. For an IBD flare, treatment often involves escalating immunosuppression. However, in cases of active C. diff, treatment focuses on reducing immunosuppression and administering antibiotics.”

The retrospective, single-center cohort study looked at adult patients with IBD with and without C. diff to find risk factors for developing the infection and having repeat infections (recurrent C. diff). IBD-related symptoms and medical history information in the three months prior to C. diff diagnosis were collected from electronic patient charts at Helsinki University Hospital and compared with age- and sex-matched patients without C. diff, and outcomes of infection were assessed for two to six months postinfection.

A total of 279 patients with IBD and C. diff infection along with 277 controls with IBD were included in the analysis. The median age of infection among patients in the C. diff cohort was 37 years, and 57% were men. Ulcerative colitis (UC) was the most common IBD subtype across groups (70% of patients with C. diff infection and 58% of controls).

Recurrent C. diff infections were reported in 30% of patients (84 individuals), with 67% of those episodes occurring within 90 days from the preceding infection. Patients with UC appear to be especially vulnerable, as 79% of the recurrent group were diagnosed with the condition.

Investigators found that active IBD, recent diagnosis and corticosteroid use were common risk factors. Advanced therapies were not associated with C. diff and biologicals appeared to be relatively safe among patients regarding infections.

Among the cohort, C. diff infection often led to more aggressive IBD treatments and hospitalizations but did not increase the need for colectomy.

The study was strengthened by the relatively young sample of patients with minimal comorbidities, a large cohort size and well-documented C. diff episodes. Because of this, investigators were able to determine the impact of disease activity on the occurrence of C. diff infection and the effect of infection on IBD activity.

However, investigators noted the retrospective study design and their inability to match medications and IBD subtypes between cases and controls as limitations of their findings. Additionally, they could not confirm disease activity through endoscopy.

“Patients with signs of active IBD and a short duration of the disease may benefit from proactive treatment of IBD and more frequent monitoring in the early stages, as these patients appear to be at higher risk of developing C. diff,” investigators concluded.