Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2025; 17(4): 100555
Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.100555
Association of Clostridium difficile infection with clinical outcomes of patients with inflammatory bowel disease: A meta-analysis
Hai-Xin Qi, Qi Wang, Gui-Qun Zhou
Hai-Xin Qi, Department of Anorectal Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou 310003, Zhejiang Province, China
Qi Wang, The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
Gui-Qun Zhou, Department of Gastroenterology, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
Author contributions: Qi HX conceived and designed the study; Qi HX, Wang Q, and Zhou GQ collected the data and performed the analysis; Qi HX was involved in the writing of the manuscript and is responsible for the integrity of the study; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gui-Qun Zhou, Department of Gastroenterology, The Third Affiliated Hospital of Zhejiang Chinese Medical University, No. 219 Moganshan Road, Hangzhou 310005, Zhejiang Province, China. 18258229818@163.com
Received: August 19, 2024
Revised: January 7, 2025
Accepted: February 5, 2025
Published online: April 27, 2025
Processing time: 221 Days and 8.1 Hours
Abstract
BACKGROUND

Clostridium difficile infection (CDI) is common in patients with inflammatory bowel disease (IBD).

AIM

To assess the association of CDI with clinical outcomes of IBD.

METHODS

PubMed, EMBASE, Web of Science, and the Cochrane Library databases were searched from inception to March 2024. Eligible articles included observational studies that reported on outcomes such as mortality, colectomy, hospitalization, intensive care unit (ICU) admission, complication rates, and length of hospital stay in IBD patients with and without CDI. Data were extracted, and a random-effects model was used to calculate pooled odds ratios (ORs) and mean differences (MDs).

RESULTS

As shown in the data from 21 studies with 1249158 participants, CDI significantly increased the risk of mortality in IBD patients [pooled OR = 4.569, 95% confidence intervals (95%CI): 2.584 to 8.079]. Although the pooled OR for colectomy was 1.409 (95%CI: 0.922 to 2.155), it was not statistically significant. Similarly, CDI did not impact hospitalization (pooled OR = 1.056, 95%CI: 0.512 to 2.179) and ICU admission outcomes (pooled OR = 1.970, 95%CI: 0.420 to 9.246) of patients with IBD. The rate of complications was comparable in the two groups (pooled OR = 0.658, 95%CI: 0.378 to 1.147). However, CDI was associated with a significantly more extended hospital stay (pooled MD = 0.349 days, 95%CI: 0.002 to 0.696).

CONCLUSION

CDI is linked to increased mortality and prolonged hospitalization in IBD patients. These results emphasize the need for early detection and appropriate management. Implementing routine CDI screening during IBD flare-ups and stringent infection control measures could mitigate severe complications and reduce the healthcare burden.

Keywords: Clostridium difficile infection; Inflammatory bowel disease; Mortality; Colectomy; Hospitalization; Meta-analysis

Core Tip: Clostridium difficile infection (CDI) significantly complicates the management of patients with inflammatory bowel disease (IBD), exacerbating disease severity and leading to worse clinical outcomes. This systematic review and meta-analysis demonstrated the association of CDI with increased mortality and prolonged hospital stays in IBD patients. While CDI was not significantly linked to colectomy or other complications, its impact on healthcare resource utilization underscores the need for routine screening, timely treatment, and robust infection control measures. These findings provide critical insights into optimizing care strategies and reducing the burden of CDI in IBD management.