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World J Gastroenterol. Sep 7, 2014; 20(33): 11736-11742
Published online Sep 7, 2014. doi: 10.3748/wjg.v20.i33.11736
Impact of Clostridium difficile infection on inflammatory bowel disease outcome: A review
Anca Trifan, Carol Stanciu, Oana Stoica, Irina Girleanu, Camelia Cojocariu
Anca Trifan, Camelia Cojocariu, “Gr. T. Popa” University of Medicine and Pharmacy, “St. Spiridon” Emergency Hospital, Institute of Gastroenterology and Hepatology, 7000111 Iasi, Romania
Carol Stanciu, “St. Spiridon” Emergency Hospital, Institute of Gastroenterology and Hepatology, 7000111 Iasi, Romania
Oana Stoica, Irina Girleanu, “Gr. T. Popa” University of Medicine and Pharmacy, 7000111 Iasi, Romania
Author contributions: Trifan A contributed to the conception and design of the review, analyzed the data, coordinated the manuscript drafting and critical revision of the manuscript; Stanciu C contributed to the conception and the design of the review, analyzed the data, coordinated the manuscript drafting and revised it critically; Stoica O and Girleanu I performed acquisition of data; Cojocariu C participated in the design of the review, collected the data; all authors read and approved the final version of the manuscript.
Correspondence to: Carol Stanciu, MD, PhD, FRCP, Professor, “St. Spiridon” Emergency Hospital, Institute of Gastroenterology and Hepatology, Independentei 1, 7000111 Iasi, Romania. stanciucarol@yahoo.com
Telephone: +40-732-402860 Fax: +40-232-246611
Received: February 11, 2014
Revised: April 23, 2014
Accepted: June 12, 2014
Published online: September 7, 2014
Processing time: 207 Days and 18.1 Hours
Abstract

Although a considerable number of studies support a substantial increase in incidence, severity, and healthcare costs for Clostridium difficile infection (CDI) in inflammatory bowel disease (IBD), only few evaluate its impact on IBD outcome. Medline and several other electronic databases from January 1993 to October 2013 were searched in order to identify potentially relevant literature. Most of the studies showed that IBD patients with CDI present a greater proportion of worse outcomes than those without CDI. These patients have longer length of hospital stay, higher rates of colectomies, and increased mortality. Patients with ulcerative colitis are more susceptible to CDI and have more severe outcomes than those with Crohn’s disease. However, studies reported variable results in both short- and long-term outcomes. Contrasting results were also found between studies using nationwide data and those reporting from single-center, or between some North-American and European studies. An important limitation of all studies analyzed was their retrospective design. Due to contrasting data often provided by retrospective studies, further prospective multi-center studies are necessary to evaluate CDI impact on IBD outcome. Until then, a rapid diagnosis and adequate therapy of infection are of paramount importance to improve IBD patients’ outcome. The aim of this article is to provide up to date information regarding CDI impact on outcome in IBD patients.

Keywords: Clostridium difficile infection; Ulcerative colitis; Crohn's disease; Outcome

Core tip: This review summarizes the impact of Clostridium difficile infection (CDI) on inflammatory bowel disease (IBD) outcome. Most of the studies showed that IBD patients with CDI have more of the whole range of short- and long-term worst outcomes than those without CDI. Patients with ulcerative colitis have more severe outcomes than those with Crohn’s disease. A prompt diagnosis and adequate treatment of CDI are of paramount importance to improve IBD patients’ outcome.