Table 3.
Outcomes of inflammatory bowel disease patients with Clostridium difficile infection
| Ref. | Patient population | Sampling time frame | Study design | n | Outcomes |
| Razik et al[44] (2016) | Adult CDI | 2010-2013 | Retrospective, single-center, cohort study | 503 | Incidence of rCDI |
| IBD + CDI | IBD > non-IBD [2.04/100 person-months (95%CI: 1.55-2.64) vs 1.25 episodes per 100 person-months (95%CI: 1.05-1.48)] | ||||
| Inpatient | Colectomy | ||||
| IBD > non-IBD (6.4% vs 0.3%) | |||||
| Skowron et al[61] (2016) | Adult IBD + IPAA | 2000-2010 | Retrospective, observational, single-center cohort study | 417 | CDI pre-colectomy associated with post-reconstruction pouch failure (HR = 3.02 95%CI: 1.23-7.44) |
| Inpatient (United States) | |||||
| McCurdy et al[54] (2016) | Adult IBD | 2005-2011 | Retrospective, case-control, single-center, study | 248 | Colectomy-free survival at 1 yr |
| IBD + CMV | IBD + CDI > IBD + CMV + CDI (71.5% vs 30%) | ||||
| IBD + CMV + CDI | IBD + CMV controls > IBD + CMV + CDI (57.1% vs 30%) | ||||
| IBD + CDI | |||||
| Inpatient and outpatient (United States) | |||||
| Negrón et al[32] (2014) | Adult UC | 2000-2009 | Retrospective, case-control, multi-center, database study | 481 | Emergent surgery |
| Inpatient (Canada) | CDI + UC > UC alone [OR = 3.39 (95%CI: 1.02-11.23)] | ||||
| Development of new infectious postoperative complication | |||||
| CDI + UC > UC alone (OR = 4.76, 95%CI: 1.10-20.63) | |||||
| Horton et al[70] (2014) | Adult IBD | 2006-2010 | Retrospective, observational, single-center study | 114 | Readmission: |
| Inpatient (United States) | UC + CDI > CD + CDI (24% vs 10%, P = 0.04) | ||||
| IBD + steroids > no-steroids (29% vs 8%, P < 0.01) | |||||
| Colectomy: | |||||
| UC + CDI > CD + CDI, index admission (27.4% vs 0%, P < 0.01) | |||||
| IBD + steroids > no-steroids (32% vs 6%, P < 0.01) | |||||
| Pant et al[98] (2013) | Pediatric IBD | 2000, 2003, 2006, 2009 | Retrospective, nested case-control, nationwide database study | 12610 | LOS: |
| Inpatient (United States) | CDI + IBD > IBD (8.0 vs 6.0, aRC = 2.1 d, 95%CI: 1.4-2.8) | ||||
| Hospitalization cost: | |||||
| CDI + IBD > IBD alone ($45126 vs $34703, aRC = $11506, 95%CI: 6192-16829) | |||||
| Parenteral nutrition: | |||||
| CDI + IBD > IBD alone (15.9% vs 12.1% aOR = 1.5, 95%CI: 1.1-2.0) | |||||
| Blood transfusions: | |||||
| CDI + IBD > IBD alone (17.7% vs 9.8%, aOR = 1.8, 95%CI: 1.4-2.4). | |||||
| Li et al[34] (2013) | Adult IBD + IPAA | 2010-2011 | Prospective, single-center, cohort study | 196 | 42.9% cured by single course of Vancomycin |
| Outpatient (United States) | 57.1% recurrent/refractory CDI | ||||
| Chu et al[103] (2013) | Adult UC + CDI | 2002-2012 | Retrospective, single-center, observational study | 23 | Morbidity and mortality after colectomy: |
| Inpatient (United States) | UC + CDI + full antibiotic course pre-op = UC + CDI + incomplete antibiotic course pre-op | ||||
| Ananthakrishnan et al[55] (2013) | Adult IBD | 2007 | Retrospective, nested case-control, nationwide database study | 67221 hospitalizations | Mortality: |
| Inpatient (United States) | CDI + IBD vs IBD alone (OR = 3.23, 95%CI: 2.55-4.03). | ||||
| Murthy et al[31] (2012) | Adult UC | 2002-2008 | Retrospective, database, cohort study | 2016 | Mortality: |
| Inpatient (Canada) | CDI + UC > UC alone, 5-yr risk (aHR = 2.40, 95%CI: 1.37-4.20) | ||||
| CDI + UC > UC alone, index hospitalization (aHR = 8.90, 95%CI: 2.80-28.3) | |||||
| CDI + UC > UC alone, 5 years post-discharge (aHR = 2.41, 95%CI: 1.37-4.22) | |||||
| Navaneethan et al[60] (2012) | Adult UC | 2002-2007 | Retrospective, single-center, cohort study | 146 | UC-related ER visits: |
| Inpatient and outpatient (United States) | CDI + UC vs UC alone, 1 yr post index infection (37.8% vs 4%, P < 0.001) | ||||
| Colectomy: | |||||
| CDI + UC vs UC alone, 1 yr post index infection (35.6% vs 9.9%, P < 0.001) | |||||
| CDI associated with colectomy within 1 yr (OR = 10, 95%CI: 2.7-36.3) | |||||
| Escalation in therapy: | |||||
| CDI + UC year after CDI admission vs year prior (55.8% vs 12.9%, P < 0.0001) | |||||
| Jen et al[57] (2011) | Adult IBD | 2002-2008 | Retrospective, nested case-control, nationwide database study | 241478 hospitalizations | Mortality: |
| Inpatient (England) | IBD + CDI (defined as hospital-acquired > IBD alone (aOR = 6.32, 95%CI: 5.67-7.04) | ||||
| LOS: | |||||
| IBD + CDI > IBD alone (27.9 d longer) | |||||
| GI surgery: | |||||
| IBD + CDI > IBD alone (aOR = 1.87, 95%CI: 0.60-5.85) | |||||
| Kariv et al[43] (2011) | Adult UC | 2000-2006 | Single-center | 78 | Colectomy within 3 mo not associated with CDI |
| Inpatient and outpatient (United States) | No UC or CDI associated mortality identified | ||||
| Ananthakrishnan et al[58] (2011) | Adult IBD | 1998, 2004, 2007 | Retrospective, nested case-control, nationwide database study | - | Mortality: |
| Inpatient (United States) | IBD + CDI > IBD alone, from 1998 to 2007 (OR = 2.38, 95%CI: 1.52-3.72 to OR = 3.38, 95%CI: 2.66-4.29). | ||||
| Kelsen et al[62] (2011) | Pediatric IBD | 1997-2007 | Retrospective, nested case-control, single-center study | 315 | rCDI: |
| Inpatient (United States) | CDI + IBD > CDI-alone (34% vs 7.5%, P < 0.0001) | ||||
| Escalation in therapy: | |||||
| IBD + CDI > IBD alone (67% vs 30%, P < 0.001) | |||||
| Jodorkovsky et al[59] (2010) | Adult UC | 2004-2005 | Retrospective, single-center, case-control study | 99 | UC-related hospitalizations: |
| Inpatient (United States) | CDI + IBD > IBD alone, over 1 yr | ||||
| Colectomy: | |||||
| CDI at index admission predictor for colectomy within 1 yr (OR = 2.38, 95%CI: 1.01-5.6) | |||||
| CDI status not a significant predictor for requirement for emergent colectomy at index admission | |||||
| LOS: | |||||
| CDI + IBD = IBD alone | |||||
| Ben-Horin et al[64] (2010) | Adult IBD + CDI | 2000-2008 | Retrospective, multi-center, cohort study | 93 | Morbidity and mortality: |
| Inpatient (Europe/Israel) | IBD + CDI patients + pseudomembranes on endoscopy = IBD + CDI without pseudomembranes | ||||
| Nguyen et al[17] (2008) | IBD and non-IBD controls | 1998-2004 | Retrospective, nested case-control, nationwide database study | 116842 hospitalizations | Mortality: |
| Inpatient (United States) | UC + CDI > CDI alone (OR = 3.79, 95%CI: 2.84-5.06) | ||||
| LOS: | |||||
| CD + CDI > CDI alone | |||||
| Hospitalization cost: | |||||
| UC + CDI > CDI alone |
CDI: Clostridium difficile infection; rCDI: Recurrent clostridium difficile infection; IBD: Inflammatory bowel disease; UC: Ulcerative colitis; CD: Crohn’s disease; IPAA: Ileal anal-pouch anastomosis; CMV: Cytomegalovirus; OR: Odds ratio; aOR Adjusted odds ratio; aRC: Adjusted regression coefficient; LOS: Length of stay.