Management of inflammatory bowel disease with Clostridium difficile infection

Table 3 Outcomes of inflammatory bowel disease patients with Clostridium difficile infection

Ref.	Patient population	Sampling time frame	Study design	n	Outcomes
Razik et al[44] (2016)	Adult CDI	2010-2013	Retrospective, single-center, cohort study	503	Incidence of rCDI
	IBD + CDI				IBD > non-IBD [2.04/100 person-months (95%CI: 1.55-2.64) vs 1.25 episodes per 100 person-months (95%CI: 1.05-1.48)]
	Inpatient				Colectomy
					IBD > non-IBD (6.4% vs 0.3%)
Skowron et al[61] (2016)	Adult IBD + IPAA	2000-2010	Retrospective, observational, single-center cohort study	417	CDI pre-colectomy associated with post-reconstruction pouch failure (HR = 3.02 95%CI: 1.23-7.44)
	Inpatient (United States)
McCurdy et al[54] (2016)	Adult IBD	2005-2011	Retrospective, case-control, single-center, study	248	Colectomy-free survival at 1 yr
	IBD + CMV				IBD + CDI > IBD + CMV + CDI (71.5% vs 30%)
	IBD + CMV + CDI				IBD + CMV controls > IBD + CMV + CDI (57.1% vs 30%)
	IBD + CDI
	Inpatient and outpatient (United States)
Negrón et al[32] (2014)	Adult UC	2000-2009	Retrospective, case-control, multi-center, database study	481	Emergent surgery
	Inpatient (Canada)				CDI + UC > UC alone [OR = 3.39 (95%CI: 1.02-11.23)]
					Development of new infectious postoperative complication
					CDI + UC > UC alone (OR = 4.76, 95%CI: 1.10-20.63)
Horton et al[70] (2014)	Adult IBD	2006-2010	Retrospective, observational, single-center study	114	Readmission:
	Inpatient (United States)				UC + CDI > CD + CDI (24% vs 10%, P = 0.04)
					IBD + steroids > no-steroids (29% vs 8%, P < 0.01)
					Colectomy:
					UC + CDI > CD + CDI, index admission (27.4% vs 0%, P < 0.01)
					IBD + steroids > no-steroids (32% vs 6%, P < 0.01)
Pant et al[98] (2013)	Pediatric IBD	2000, 2003, 2006, 2009	Retrospective, nested case-control, nationwide database study	12610	LOS:
	Inpatient (United States)				CDI + IBD > IBD (8.0 vs 6.0, aRC = 2.1 d, 95%CI: 1.4-2.8)
					Hospitalization cost:
					CDI + IBD > IBD alone ($45126 vs $34703, aRC = $11506, 95%CI: 6192-16829)
					Parenteral nutrition:
					CDI + IBD > IBD alone (15.9% vs 12.1% aOR = 1.5, 95%CI: 1.1-2.0)
					Blood transfusions:
					CDI + IBD > IBD alone (17.7% vs 9.8%, aOR = 1.8, 95%CI: 1.4-2.4).
Li et al[34] (2013)	Adult IBD + IPAA	2010-2011	Prospective, single-center, cohort study	196	42.9% cured by single course of Vancomycin
	Outpatient (United States)				57.1% recurrent/refractory CDI
Chu et al[103] (2013)	Adult UC + CDI	2002-2012	Retrospective, single-center, observational study	23	Morbidity and mortality after colectomy:
	Inpatient (United States)				UC + CDI + full antibiotic course pre-op = UC + CDI + incomplete antibiotic course pre-op
Ananthakrishnan et al[55] (2013)	Adult IBD	2007	Retrospective, nested case-control, nationwide database study	67221 hospitalizations	Mortality:
	Inpatient (United States)				CDI + IBD vs IBD alone (OR = 3.23, 95%CI: 2.55-4.03).
Murthy et al[31] (2012)	Adult UC	2002-2008	Retrospective, database, cohort study	2016	Mortality:
	Inpatient (Canada)				CDI + UC > UC alone, 5-yr risk (aHR = 2.40, 95%CI: 1.37-4.20)
					CDI + UC > UC alone, index hospitalization (aHR = 8.90, 95%CI: 2.80-28.3)
					CDI + UC > UC alone, 5 years post-discharge (aHR = 2.41, 95%CI: 1.37-4.22)
Navaneethan et al[60] (2012)	Adult UC	2002-2007	Retrospective, single-center, cohort study	146	UC-related ER visits:
	Inpatient and outpatient (United States)				CDI + UC vs UC alone, 1 yr post index infection (37.8% vs 4%, P < 0.001)
					Colectomy:
					CDI + UC vs UC alone, 1 yr post index infection (35.6% vs 9.9%, P < 0.001)
					CDI associated with colectomy within 1 yr (OR = 10, 95%CI: 2.7-36.3)
					Escalation in therapy:
					CDI + UC year after CDI admission vs year prior (55.8% vs 12.9%, P < 0.0001)
Jen et al[57] (2011)	Adult IBD	2002-2008	Retrospective, nested case-control, nationwide database study	241478 hospitalizations	Mortality:
	Inpatient (England)				IBD + CDI (defined as hospital-acquired > IBD alone (aOR = 6.32, 95%CI: 5.67-7.04)
					LOS:
					IBD + CDI > IBD alone (27.9 d longer)
					GI surgery:
					IBD + CDI > IBD alone (aOR = 1.87, 95%CI: 0.60-5.85)
Kariv et al[43] (2011)	Adult UC	2000-2006	Single-center	78	Colectomy within 3 mo not associated with CDI
	Inpatient and outpatient (United States)				No UC or CDI associated mortality identified
Ananthakrishnan et al[58] (2011)	Adult IBD	1998, 2004, 2007	Retrospective, nested case-control, nationwide database study	-	Mortality:
	Inpatient (United States)				IBD + CDI > IBD alone, from 1998 to 2007 (OR = 2.38, 95%CI: 1.52-3.72 to OR = 3.38, 95%CI: 2.66-4.29).
Kelsen et al[62] (2011)	Pediatric IBD	1997-2007	Retrospective, nested case-control, single-center study	315	rCDI:
	Inpatient (United States)				CDI + IBD > CDI-alone (34% vs 7.5%, P < 0.0001)
					Escalation in therapy:
					IBD + CDI > IBD alone (67% vs 30%, P < 0.001)
Jodorkovsky et al[59] (2010)	Adult UC	2004-2005	Retrospective, single-center, case-control study	99	UC-related hospitalizations:
	Inpatient (United States)				CDI + IBD > IBD alone, over 1 yr
					Colectomy:
					CDI at index admission predictor for colectomy within 1 yr (OR = 2.38, 95%CI: 1.01-5.6)
					CDI status not a significant predictor for requirement for emergent colectomy at index admission
					LOS:
					CDI + IBD = IBD alone
Ben-Horin et al[64] (2010)	Adult IBD + CDI	2000-2008	Retrospective, multi-center, cohort study	93	Morbidity and mortality:
	Inpatient (Europe/Israel)				IBD + CDI patients + pseudomembranes on endoscopy = IBD + CDI without pseudomembranes
Nguyen et al[17] (2008)	IBD and non-IBD controls	1998-2004	Retrospective, nested case-control, nationwide database study	116842 hospitalizations	Mortality:
	Inpatient (United States)				UC + CDI > CDI alone (OR = 3.79, 95%CI: 2.84-5.06)
					LOS:
					CD + CDI > CDI alone
					Hospitalization cost:
					UC + CDI > CDI alone

CDI: Clostridium difficile infection; rCDI: Recurrent clostridium difficile infection; IBD: Inflammatory bowel disease; UC: Ulcerative colitis; CD: Crohn’s disease; IPAA: Ileal anal-pouch anastomosis; CMV: Cytomegalovirus; OR: Odds ratio; aOR Adjusted odds ratio; aRC: Adjusted regression coefficient; LOS: Length of stay.