Risk factors of Clostridium difficile infection in patients with inflammatory bowel disease accompanied with diarrhea and its impact on short-term prognosis / 中华消化杂志

ABSTRACT

Objective To analyze the prevalence of Clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD) accompanied with diarrhea in order to analyze the possible risk factors and its impact on short-term prognosis.Methods From January 2013 to June 2015,a total of 169 IBD patients with diarrhea who visited Rui Jin Hospital,School of Medicine,Shanghai Jiaotong University were enrolled,and in the same period 184 non-IBD patients with diarrhea were enrolled as control group.Clinical data of IBD patients with diarrhea were collected.Clostridium difficile toxins A and B of stool specimens of all included patients were detected with enzyme immunoassay.T test,chi-square test and logistic regression analysis were performed for statistical analysis.Results Among 169 IBD patients with diarrhea,there were 137 adults and 32 children.The positive rate of CDI of IBD patients with diarrhea (9.5％,16/169) was higher than that of non-IBD patients with diarrhea (1.1％,2/184),and the difference was statistically significant (x2 =12.785,P ＜ 0.0l).The positive rate of CDI in adults and children with IBD accompanied with diarrhea were 7.3％ (10/137),and 18.8％ (6/32),respectively.Among 16 CDI-positive IBD patients with diarrhea,10 patients had hospitalization history before admission,and the rate of previous hospitalizations was higher than that of CDI-negative IBD patients with diarrhea (37.3％,57/153),and the difference was statistically significant (x2 =2.875,P =0.01,odds ratio (OR) =1.26,95％ confidence interval (CI) 0.78 to 2.03).Furthermore,among 16 CDI-positive IBD patients with diarrhea,14 patients had been treated with antibiotic drugs before,the antibiotic utilization rate was higher than that of CDI-negative IBD patients with diarrhea (34.6％,53/153),and the difference was statistically significant (x2 =14.778,P ＜ 0.01,OR =24.74,95％ CI 3.15 to 194.46).However,there was no statistically significant difference in the length of hospitalization,incidence of bowel surgery and usage of inflaximab within six months after Clostridium difficile detection between the CDI-positive group and CDInegative group of 1BD patients with diarrhea (all P ＞ 0.05).Conclusions The incidence of CD1 in IBD patients with diarrhea increases.The risk factors include history of previous hospitalization before admission and antibiotic usage.However there is no significant correlation between CDI and short-term prognosis of IBD.