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Clostridium difficile infection in inflammatory bowel disease

epidemiology over two decades

Moens, Annicka,c; Verstockt, Brama,c; Machiels, Kathleenc; Bossuyt, Peterd; Verdonck, Annb; Lagrou, Katrienb; van Assche, Gerta,c; Vermeire, Séverinea,c; Ferrante, Marca,c

European Journal of Gastroenterology & Hepatology: June 2019 - Volume 31 - Issue 6 - p 668–673
doi: 10.1097/MEG.0000000000001394
Original Articles: Gastroenterology

Background The incidence of Clostridium difficile infection (CDI) has been rising in the overall population as well as in patients with inflammatory bowel disease (IBD). However, the incidence of CDI in IBD may be changing owing to alterations in medical therapies.

Objective The aim of this study was to establish the incidence of CDI in IBD over the past two decades and compare risk factors, disease characteristics and outcomes between IBD and non-IBD patients.

Patients and methods In this retrospective case–control study, the incidence of CDI in IBD was followed for 18 years. The electronic database of our centre was reviewed for all stool samples received from patients admitted to gastroenterology wards or visiting the outpatient clinic. Diagnosis of CDI was based on diagnostic criteria that evolved throughout the years.

Results IBD patients (n=44) with CDI were found to be younger (P=0.0001), have less cardiovascular comorbidity (P=0.023), fewer prior hospitalizations (P=0.009) and fewer prior antibiotic use (P=0.005). More IBD patients were on biologic therapy (P=0.0001) or steroids (P=0.001) but less likely taking proton pump inhibitors (P=0.001). The number of stool testing per year increased as well as the median number of positive stool samples for CDI (2% in 2000–2008 to 3% in 2009–2017, P=0.032). Pseudomembranes were only seen in non-IBD patients (28%, P=0.048). There was no difference in the choice of antibiotics between IBD and non-IBD patients [metronidazole (36 vs. 51%) and vancomycin (36 vs. 26%), P=0.090 and 0.190]. The 1-year mortality rate was lower in IBD patients compared with non-IBD patients (0 vs. 32%, P=0.0001).

Conclusion In the past two decades, the incidence of CDI in IBD and non-IBD patients has increased. However, the overall outcome of CDI in IBD patients was favourable compared with non-IBD patients.

Departments of aGastroenterology and Hepatology

bLaboratory Medicine, University Hospitals Leuven

cDepartment of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven

dDepartment of Gastroenterology and Hepatology, Imelda Hospital, Bonheiden, Belgium

The study was presented as poster presentation at European Crohn’s and Colitis Organisation, 17 February 2018, Vienna, Austria; at Belgian Week of Gastroenterology, 22 February 2018, Antwerp, Belgium; at Digestive Disease Week, 2–6 June 2018, Washington, DC, USA.

Correspondence to Marc Ferrante, MD, PhD, Department of Gastroenterology and Hepatology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium Tel: +32 016 344 218; fax: +32 016 344 419; e-mail:

Received November 26, 2018

Accepted February 11, 2019

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