Risk factors associated with Clostridium difficile infection in inflammatory bowel disease: a systematic review and meta-analysis.

Risk factors associated with Clostridium difficile infection in inflammatory bowel disease: a systematic review and meta-analysis.

J Crohns Colitis. 2018 Sep 21;:

Authors: Balram B, Battat R, Al-Khoury A, D’Aoust J, Afif W, Bitton A, Lakatos PL, Bessissow T

Abstract
Background: Clostridium difficile Infection (CDI) is a significant concern in Inflammatory Bowel Disease (IBD). Risk factors and consequences associated with CDI in Inflammatory Bowel Disease (IBD) patients are important to characterize.
Aim: To perform a systematic review and meta-analysis to assess risk factors and outcomes associated with CDI in IBD patients.
Methods: Multiple databases were searched for studies investigating risk factors, colectomy and mortality risk in IBD patients with and without CDI. This was stratified by short (<3 months) and long-term (>1 year) outcomes. Summary estimates were calculated using a random-effects model. Quality assessment used the Newcastle-Ottawa scale.
Results: Twenty-two studies met inclusion criteria. Antibiotics use within 30 days of diagnosis was associated with CDI infections (OR: 1.85, 95% CI:1.36, 2.52). Colonic involvement in Crohn’s disease patients was associated with significantly higher CDI infection rates (OR: 2.76, 95% CI:1.75, 4.35). There was a significant association between biologic medication use and CDI (OR: 1.65 [1.18, 2.30]), with minimal heterogeneity (I 2= 4.0%). The long-term colectomy risk was significantly higher for IBD patients with CDI compared to without CDI (OR: 2.22, 95% CI: 1.17, 4.18). Significantly higher mortality was found in CDI in IBD patients both short-term (OR:3.84, 95%CI: 2.62, 5.61) and long-term (OR: 3.65, 95% CI:1.58, 8.44). Substantial heterogeneity existed. Most studies were moderate quality.
Conclusion: Colonic involvement, biologic and antibiotic use appear to be risk factors associated with CDI amongst IBD patients. CDI is associated with increased short and long-term mortality.

PMID: 30247650 [PubMed – as supplied by publisher]

PubMed Link: https://www.ncbi.nlm.nih.gov/pubmed/30247650?dopt=Abstract