Purpose: Little is known about the frequency, management and outcomes of outpatients with infectious complications of inflammatory bowel disease. We sought to characterize the organisms causing infectious exacerbations at our IBD center. Methods: We performed a retrospective analysis of exacerbations in IBD patients under the care of a single gastroenterologist from January 2008 to 2010. Patient exacerbations had clinical signs and symptoms and required modification of therapy. All had stool for culture, O and P, and C. diff toxin except for 8 patients. We identified patient demographics, disease course and therapy. We documented outcomes including mortality, ICU admissions, surgical interventions, and hospitalizations. Results: We identified 180 IBD patients with 112 exacerbations. 37 (33%) had C. diff infection (19 male, 18 female, mean age 34). Of the patients with C. diff, 2 patients had coinfection with giardia, 1 with shigella, 1 with CMV. No other organisms were detected. In patients with C. diff, 19 had ulcerative colitis and 18 had Crohn's disease (all with colon involvement). 65% of patients had identifiable risk factors for C. diff infection. Baseline therapy in these patients included: 8% anti-TNF, 16% combination immunosuppressives; 19% steroids; 3% 6MP; 5% topical steroids. 80% were on mesalamine. C. diff was treated with vancomycin in 49%, vancomycin and metronidazole in 35%, and metronidazole in 16%. Besides antibiotics, 3 patients were started on 6MP, and 2 had their dose of 6MP increased. Mesalamine was started or the dose increased in 51%. 81% of patients required the addition of corticosteroids, half needing IV steroids. No patient died, needed surgical intervention, or ICU admission during the study period. 57% required hospital admission, usually for IV steroid treatment. 24% had recurrent C. diff infection. Conclusion: In our cohort of IBD patients, infectious exacerbations were associated primarily with C. diff. infection. Aggressive medical management with steroids, antibiotics, and additional combination therapy resulted in a good outcome as defined by no mortality, surgical intervention or ICU admission.