Risk factors and prognosis of Clostridium difficile infection among 216 hospitalized patients with inflammatory bowel disease

Abstract

Objective To analyze the risk factors and prognosis of Clostridium difficile infection (CDI) among hospitalized patients with inflammatory bowel disease (IBD). Methods From March 2014 to February 2015, 216 first-time hospitalized patients with IBD were enrolled. Once hospitalized, stool samples were obtained for Clostridium difficile culture immediately, and at the same time toxins of Clostridium difficile (tcd) A and tcdB were detected by polymerase chain reaction(PCR). The incidence and risk factors of CDI in enrolled patients were analyzed. Chi square test and nonparametric test were performed for statistical analysis. Results Among the 216 IBD patients, there were 73 patients with ulcerative colitis(UC) and 143 patients with Crohn′s disease(CD). The positive rate of CDI was 13.9%(30/216) in IBD patients. The positive rate of CDI was 24.7%(18/73) in UC patients, which was higher than that of CD patients (8.4%, 12/143), and the difference was statistically significant (χ2=10.690, P<0.01). As the severity of the disease increased, the rate of CDI positive patients in UC patients increased. Among three patients at remission period, 17 patients at mild active stage, 23 patients at moderate active stage and 30 patients at severe active stage, the CDI positive patients were zero, two, five, 11, respectively, and the difference was statistically significant (χ2=4.820, P=0.028). In UC patients, the incidences of patients with hospitalization history in other hospitals within three months before admission in CDI positive group and negative group were 6/18 and 7.3% (4/55), respectively, and the difference was statistically significant (χ2=5.740, P=0.020). In 30 days before admission, the rates of patients with proton pump inhibitor (PPI) taking history of two groups were 7/18 and 7.3%(4/55), and the difference was statistically significant (χ2=8.270, P=0.004). The length of hospital stay in CDI negative UC patients was 7.0 d (5.0 d, 12.0 d), which was shorter than that of CDI positive patients (10.5 d (8.8 d, 18.2 d)), and the difference was statistically significant (U=277.000, P=0.005). The rate of patients underwent intestinal operation in CDI negative CD patients within three months after CDI examination was 10.7%(14/131), which was significantly lower than that of CDI positive patients (5/12)(χ2=4.520, P=0.010). Conclusions The incidence of CDI in hospitalized IBD patients was high, especially in UC patients; the risk factors included disease severity, prior hospitalization history within three months before admission and PPI taking history within 30 days before admission. CDI was correlated with poor prognosis. Key words: Inflammatory bowel diseases; Colitis, ulcerative; Crohn disease; Clostridium difficile; Epidemiology; Risk factors