Abstract

Patients with More Severe IBD Get Clostridioides difficile Rather than Clostridioides difficile Increasing the Severity of IBD

Dig Dis Sci. 2020 Jul 29. doi: 10.1007/s10620-020-06504-y. Online ahead of print.

Sanskriti Varma 1, Adam S Faye 2, Adithya Kannan 3, Garrett Lawlor 2, Abhishek Verma 4, Jordan Axelrad 5, Daniel E Freedberg 2

 
     

Author information

  • 1Department of Medicine, New York Presbyterian Columbia University Medical Center, 630 West 168th Street, New York, NY, 10032, USA. sav9046@nyp.org.
  • 2Division of Digestive and Liver Diseases, Department of Medicine, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, NY, 10032, USA.
  • 3Vagelos College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY, 10032, USA.
  • 4Department of Medicine, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA.
  • 5Division of Gastroenterology and Hepatology, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA.

Abstract

Background: Inflammatory bowel disease (IBD) patients who have Clostridioides difficile infection (CDI) have worse outcomes.

Aims: We aimed to determine whether such outcomes are the result of CDI or whether CDI occurs in patients who have more severe IBD.

Methods: This was a retrospective study of patients hospitalized for ≥ 2 IBD flares from 2010 to 2019. The primary outcome was time to IBD flare between hospitalizations. First, time to flare was compared between patients who were hospitalized for a flare complicated by CDI and subsequently for a CDI-negative flare (cohort A, denoted +/-) versus patients who were hospitalized for two CDI-negative flares (cohort B, -/-). Second, time between flares was compared within the subset of cohort A patients who had three flares (cohort C, -/+/-) before and after CDI.

Results: Time between flares was a median of 4 months (IQR 1-9) among 51 cohort A patients versus 12 months (IQR 6-38) among 51 cohort B patients (log-rank P < 0.01). In contrast, the median time between flares was similar within cohort C before and after CDI (log-rank P = 0.54). At time of the second IBD flare, patients in cohort A (+/-) were more likely to have moderate or severe disease compared to patients in cohort B (-/-).

Conclusions: Patients with prior CDI had shorter time to subsequent IBD flare relative to their CDI-negative counterparts. This is not likely due to CDI itself because there was no difference in time between flares before versus after acquiring CDI. Rather, patients who acquire CDI may have more severe IBD.

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