J Korean Med Sci.  2023 Dec;38(47):e359. 10.3346/jkms.2023.38.e359.

The Prevalence and Risk Factors of Clostridioides difficile Infection in Inflammatory Bowel Disease: 10-Year South Korean Experience Based on the National Database

• Song EM
• Choi A
• Kim S
• Jung SH

• KMID: 2548801
• DOI: http://doi.org/10.3346/jkms.2023.38.e359

Abstract

Background
Few studies evaluate the epidemiology and risk factors of Clostridioides difficile infection (CDI) in Asian patients with inflammatory bowel disease (IBD). We investigated the year-end prevalence, cumulative incidence and risk factors of CDI in Asian patients with IBD using a large-scale population-based cohort in Korea.
Methods
Using the National Health Insurance Service database, we identified patients with IBD and sex- and age-matched controls without IBD between 2008 and 2018. The year-end prevalence and cumulative incidence of CDI were compared among patients with Crohn’s disease (CD) and ulcerative colitis (UC) with controls. The risk factors for CDI were evaluated.
Results
Among the 54,836 patients with IBD and 109,178 controls, CDI occurred in 293 patients with IBD and 87 controls. The annual year-end prevalence of CDI in patients with IBD increased from 8.6/10,000 persons in 2008 to 22.3/10,000 persons in 2018. The risk of CDI was higher in both patients with CD and UC than that in the matched controls (hazard ratio [HR], 7.285; 95% confidence interval [CI], 5.388–9.851; P < 0.001 and HR, 7.487; 95% CI, 5.796–9.670; P < 0.001, respectively). Among patients with IBD, the risk factors for CDI included older age, female sex, high Charlson comorbidity index score, and IBD-related medications including oral 5-aminosalicylic acid, immunomodulatory agents, biologics, and steroids used for > 90 days.
Conclusion
The risk of CDI in Korean patients with IBD was approximately seven times higher than that in controls without IBD, and the annual year-end prevalence of CDI continuously increased from 2008 to 2018.

Keyword

Clostridioides difficile; Pseudomembranous Enterocolitis; Inflammatory Bowel Diseases; Crohn Disease; Ulcerative Colitis

Figure

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  Fig. 1 Flow chart of the study population.NHIS = National Health Insurance Service, IBD = inflammatory bowel disease, CDI = Clostridioides difficile infection, CD = Crohn’s disease, UC = ulcerative colitis.

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  Fig. 2 Annual year-end prevalence of CDI in patients with IBD and in non-IBD controls.CDI = Clostridioides difficile infection, IBD = inflammatory bowel disease, CD = Crohn’s disease, UC = ulcerative colitis.

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  Fig. 3 Cumulative incidence of Clostridioides difficile infection in patients with IBD and in non-IBD controls.IBD = inflammatory bowel disease, CD = Crohn’s disease, UC = ulcerative colitis.

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