Intest Res.  2019 Apr;17(2):244-252. 10.5217/ir.2018.00101.

The impact of corticosteroid use on inpatients with inflammatory bowel disease and positive polymerase chain reaction for Clostridium difficile

• Lim HW
• Schuster I
• Rajapakse
• Monzur F
• Khan S
• Sultan K

• KMID: 2449966
• DOI: http://doi.org/10.5217/ir.2018.00101

Abstract

BACKGROUND/AIMS
Optimal management of inflammatory bowel disease (IBD) with concomitant Clostridium difficile infection (CDI) is controversial, especially when CDI diagnosis is made by polymerase chain reaction (PCR) testing, which may reflect colonization without infection.
METHODS
We performed a multicenter review of all inpatients with IBD and PCR diagnosed CDI. Outcomes included length of stay, 30- and 90-day readmission, colectomy during admission and within 3 months, intensive care unit (ICU) admission, CDI relapse and death for patients who received corticosteroid (CS) after CDI diagnosis versus those that did not. Propensity-adjusted regression analysis of outcomes based on CS usage was performed.
RESULTS
We identified 177 IBD patients with CDI, 112 ulcerative colitis and 65 Crohn's disease. For IBD overall, CS after CDI diagnosis was associated with prolonged hospitalization (5.5 days: 95% confidence interval [CI], 1.5-9.6 days; P=0.008), higher colectomy rate within 3 months (odds ratio [OR], 5.5; 95% CI, 1.1-28.2; P=0.042) and more frequent ICU admissions (OR, 7.8; 95% CI, 1.5-41.6; P=0.017) versus no CS. CS use post-CDI diagnosis in UC patients was associated with prolonged hospitalization (6.2 days: 95% CI, 0.4- 12.0 days; P=0.036) and more frequent ICU admissions (OR, 7.4; 95% CI, 1.1-48.7; P=0.036).
CONCLUSIONS
CS use among IBD inpatients with CDI diagnosed by PCR is associated with poorer outcomes and would seem to reinforce the importance of C. difficile toxin assay to help distinguish colonization from infection. This adverse effect appears more prominent among those with UC.

Keyword

Inflammatory bowel disease; Corticosteroids; Clostridium difficile; Adverse outcomes; Polymerase chain reaction

MeSH Terms

Adrenal Cortex Hormones
Clostridium difficile*
Clostridium*
Colectomy
Colitis, Ulcerative
Colon
Crohn Disease
Diagnosis
Hospitalization
Humans
Inflammatory Bowel Diseases*
Inpatients*
Intensive Care Units
Length of Stay
Polymerase Chain Reaction*
Recurrence
Adrenal Cortex Hormones

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