Risk Factors Associated with Clostridium difficile Infection in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Abstract Background and Aim 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. The aim of this research was to perform a syst...

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Bibliographic Details
Published in:Journal of Crohn's and colitis 2019-01, Vol.13 (1), p.27-38
Main Authors: Balram, Bhairavi, Battat, Robert, Al-Khoury, Alex, D’Aoust, Julie, Afif, Waqqas, Bitton, Alain, Lakatos, Peter L, Bessissow, Talat
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - adverse effects
Biological Products - therapeutic use
Clostridioides difficile
Colectomy - statistics & numerical data
Colon
Comorbidity
Enterocolitis, Pseudomembranous - epidemiology
Enterocolitis, Pseudomembranous - microbiology
Humans
Immunosuppressive Agents - therapeutic use
Inflammatory Bowel Diseases - drug therapy
Inflammatory Bowel Diseases - mortality
Inflammatory Bowel Diseases - surgery
Risk Factors
Time Factors
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Summary:Abstract Background and Aim 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. The aim of this research was to perform a systematic review and meta-analysis on 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 [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 CDIs (odds ratio [OR]: 1.85, 95% confidence interval [CI]:1.36, 2.52). Colonic involvement in Crohn’s disease patients was associated with significantly higher CDI rates [OR: 2.76, 95% CI: 1.75, 4.35]. There was a significant association between biologic medication use and CDI [OR: 1.65, 95% CI: 1.18, 2.30], with minimal heterogeneity [I2 = 4.0%]. The long-term colectomy risk was significantly higher for IBD patients with CDI compared with that for IBD patients without CDI [OR: 2.22, 95% CI: 1.17, 4.18]. Significantly higher mortality was found for 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 of moderate quality. Conclusion Colonic involvement, and biologic and antibiotic use appear to be risk factors associated with CDI among IBD patients. CDI is associated with increased short- and long-term mortality.
ISSN:1873-9946
1876-4479
DOI:10.1093/ecco-jcc/jjy143