Clostridium difficile infection: Is there a change in the underlying factors? Inflammatory bowel disease and Clostridium difficile

Saudi J Gastroenterol. Nov-Dec 2019;25(6):384-389. doi: 10.4103/sjg.SJG_44_19.

Abstract

Background / aims: Clostridium difficile is a Gram-positive, strict anaerobe, spore-forming bacterium. It can cause self-limiting mild diarrhea, severe diarrhea, pseudomembranous colitis, and fatal fulminant colitis. We aimed to investigate the changes in epidemiology and incidence of C. difficile infection in our hospital database.

Patients and methods: Episodes of C. difficile toxin were identified in hospital database, and data such as age, sex, community versus hospital acquisition, intensive care follow-up, current or previous treatments with antibiotics within the past 3 months, medication with proton pump inhibitors, or immunosuppressive therapies were collected.

Results: Toxin-positive 78 individuals constituted the patient group. In univariate analyses, independent risk factors for toxin positivity were community versus hospital acquisition [odds ratio (OR), 5.49; 95% confidence interval (CI), 2.52-11.95; P = 0.0001], presence of inflammatory bowel diseases (IBDs) (OR, 21.5; 95% CI, 8.65-53.44; P = 0.0001), proton pump inhibitors' use (OR, 4.53; 95% CI, 1.97-10.43; P = 0.0001), immunosuppressive drug use (OR, 4.1; 95% CI, 2.01-8.3; P = 0.0001), and use of quinolone group of antibiotics (OR, 5.95; 95% CI, 1.92-18.46; P = 0.001). Antibiotic use was a protective risk factor (OR, 0.09; 95% CI, 0.01-0.78; P = 0.01) and presence of IBDs was an independent risk factor (OR, 6.8; 95% CI, 1.5-30.08; P = 0.01) in community-acquired group (OR, 0.09; 95% CI, 0.01-0.78; P = 0.01).

Conclusion: In recent studies, C. difficile infections were demonstrated to be more frequent in younger individuals who did not have a history of hospitalization but had an underlying disease such as IBD. In our study, we showed the change in the epidemiological data with prominence of underlying diseases such as IBDs.

Keywords: Antibiotics; Clostridium difficile; Turkey; inflammatory bowel disease; risk factors.

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Case-Control Studies
  • Clostridioides difficile / drug effects
  • Clostridioides difficile / immunology*
  • Clostridium Infections / complications
  • Clostridium Infections / epidemiology*
  • Clostridium Infections / microbiology*
  • Community-Acquired Infections / epidemiology
  • Cross Infection / epidemiology
  • Female
  • Hospitalization / trends
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Inflammatory Bowel Diseases / drug therapy*
  • Inflammatory Bowel Diseases / epidemiology
  • Inflammatory Bowel Diseases / microbiology*
  • Male
  • Middle Aged
  • Proton Pump Inhibitors / therapeutic use
  • Quinolones / therapeutic use
  • Retrospective Studies
  • Risk Factors
  • Turkey / epidemiology

Substances

  • Anti-Bacterial Agents
  • Immunosuppressive Agents
  • Proton Pump Inhibitors
  • Quinolones