Background: Many reports have documented the increasing impact of Clostridium difficile infections (CDI) in patients with inflammatory bowel disease (IBD) in the latest years. To determine the prevalence, risk factors, clinical characteristics and prognosis of CDI in hospitalized ulcerative colitis (UC) patients, we conducted this retrospective analysis.
Methods: Patients with UC, hospitalized from January 2010 to December 2015 at the department of gastrointestinal in PUMCH, China were objects of this study. For all the patients suspected of CDI, stool samples were tested for toxins A and B of Clostridium difficile (CDAB) with enzyme-linked immuno sorbent assay (ELISA). Clinical data of CDAB positive patients were collected. Controls were CDAB negative patients by matching age, gender and the year CDAB tested at 1:2 ratios. Logistic regression was used to reveal the risk factors of CDI.
Results: In a total of 421 in-patients with UC, 34 (8.08%) were CDAB positive and diagnosed as CDI. 68 CDAB negative patients were matched. Univariate analyses revealed that risk factors for CDI were: antibiotic exposure within 3 months prior to CDAB test (p=0.004), prior hospitalization within 1 month (p=0.025), systemic use of steroids (p=0.002), and dose of steroids used in CDI patients was higher than non-CDI patients (p=0.001). At the meanwhile, the study found a correlation between active cytomegalovirus (CMV) infection and CDI in UC patients (p=0.001). On logistic regression analyses, active CMV infection had a significant difference between CDI and non-CDI patients (OR 13.502, 95% CI: 1.307∼139.512, p=0.029). However, the severity of UC (evaluated on clinical criteria and endoscopic scoring system), distribution of UC, disease course, duration of disease, history of smoking and alcohol use, combination of diabetes, history of surgery, 5-aminosalicylic acid (5-ASA), proton pump inhibitor (PPI), immunosuppressants except steroids, infliximab, parenteral nutrition within 1 month didn't increase the risk of CDI in UC patients. Clinical features of CDI patients in UC had no significant differences from non-CDI patients, such as body mass index (BMI), defecation frequency, toxic megacolon incidence rate, leucocyte and neutrocyte level of peripheral blood (p≥0.05). CDI didn't increase the subsequent colectomy rate in this study.
Conclusions: The complication of IBD by C. difficile infection has received increasing attention. This retrospective study found that recent usage of antibiotic, a history of prior hospitalization and systemic using of steroids increase the risk of CDI. CMV infection was an independent risk factor of CDI in patients with UC.