Burden of Clostridium Difficile Infection in Inflammatory Bowel Disease.

Objectives: Over the past two decades has been a dramatic worldwide increase in both incidence and severity of Clostridium Difficile infection (CDI). Several studies showed worse clinical outcomes in Inflammatory Bowel Disease (IBD) patients with CDI, including longer hospital stay, higher colectomy and mortality rates than in those without CDI. The aim of our study was to evaluate the prevalence of Clostridium difficile infection in IBD patients and to evaluate the particularities of diagnosis and treatment. Methodology: We performed a retrospective study that included 15 patients from a group of 220 IBD patients admitted in the Gastroenterology Department of the Clinical Emergency Hospital Bucharest between 2013- 2016 having also Clostridium Difficile infection. Results: The patients mean age was 44.1 years. The prevalence of CDI in patients with inflammatory bowel disease was 6.81%. Patients with ulcerative colitis were more susceptible to CDI (86.6%), than those with Crohn's disease (13.3%). We studied also the response to treatment. Metronidazole alone was effective in 33.3% of cases. Vancomycin combined with Metronidazole was effective in 60% of cases. Refractory CDI unresponsive to 48 hours of conventional therapy appeared in 6.6% of cases. The eradication was achieved only with Tigecycline and fecal microbiota transplant. Imunosupressive therapy was continued in all cases, concomitant with Metronidazole/Vancomicin. Conclusions: Patients with ulcerative colitis are at higher risk for CDI and have a poor prognosis than those with Crohn's disease. Average age of CDI in IBD patients significantly is lower than in general population. In IBD patients, presenting with diarrhea or a change in bowel habits, practitioners need to test for C. difficile and differentiate CDI symptoms from a disease flare. Special care to rule out C. difficile should be pursued prior to escalating or starting new immunosuppressive agents. Fecal microbiota transplant, probiotics, and newer antibiotics are good alternatives for refractory disease. [ABSTRACT FROM AUTHOR]