Risk Factors and Outcome of PCR-detected Clostridium difficile Infection in Ileal Pouch Patients

Abstract

The clinical implication of Clostridium difficile infection (CDI) in patients with ileal pouch-anal anastomosis (IPAA) for underlying inflammatory bowel disease (IBD) has not been well studied. This study was designed to investigate the cumulative incidence, risk factors, and outcome of CDI in patients with ileal pouches. Consecutive IPAA patients (n = 196) from the subspecialty Pouchitis Clinic with an increase of at least three stools per day more from the postoperative baseline for more than 4 weeks were enrolled from October 2010 to December 2011. CDI was diagnosed based on the presence of symptoms and positive polymerase chain reaction (PCR)-based stool test for C. difficile toxin B. Risk factors for CDI were assessed with univariate and multivariate analyses. All patients with CDI (n = 21) were treated with oral vancomycin (500 - 1000 mg/day) for 2-4 weeks. The treatment outcome of these patients was documented. Twenty-one patients (10.7%) were diagnosed with CDI. On univariate analysis, patients with CDI had more stool frequency (P = 0.014) and significant current weight loss (P = 0.003) than patients with no CDI. In logistic regression analysis, there was a trend that recent hospitalization (odds ratio [OR] = 4.00, 95% confidence interval [CI], 0.95-16.84) might be associated with CDI. Of the 14 CDI patients with follow-up data, eight (57.1%) had either recurrent (n = 5) or refractory (n = 3) CDI after oral vancomycin therapy. A high index of suspicion for CDI in pouch patients should be given to those with recent hospitalization or constitutional symptoms, such as weight loss. Recurrent or refractory CDI is common, even with standard oral vancomycin therapy.