Impact of Clostridioides difficile infection in patients admitted with ulcerative colitis

Abstract

Background

Patients with ulcerative colitis (UC) are at increased risk of Clostridioides difficile infection (CDI), which is the principal causative agent of nosocomial diarrhoea in western countries. This has been related to complications such as need of colectomy and mortality among these patients. The aim of this study was to assess the incidence and impact of CDI in patients hospitalised with UC.

Methods

Case–control retrospective study including patients admitted due to a UC flare from January 2000 to September 2018. Porpensity score matching (PSM) was performed to minimise selection bias taking into account the small number of cases compared to controls.

Results

339 patients were included; CDI in 35 (10.3%) patients. After PSM, 35 (33.33%) cases and 70 (66.67%) controls were analysed. Patients with CDI presented higher rates of readmission (52.9% vs. 21.4%, p = .001), increased mortality within the first 3 months post-discharge (5.9% vs. 0%, p = .042) and increased need of therapy intensification in the first year after admission (20.7% vs. 12.5%, p = .001). No risk factors for CDI were identified. Multivariable cox regression showed that treatment with 5-aminosalycilates at baseline (HR 0.42, 95% CI 0.18–0.92) and albumin <3.5 g/dL (HR 3.11, 95% CI 1.21–8.03) were associated with worse outcomes.

Conclusions

CDI is a prevalent situation in hospitalised UC patients related to higher mortality within the first 3 months after the infection, need for therapy intensification within the first year and readmission. Our results underline the importance of CDI detection in patients with a flare of UC.

Keywords:

• Ulcerative colitis
• Clostridioides difficile
• inflammatory bowel disease
• colectomy
• enteric infection

Acknowledgements

The authors would like to thank Medical Science Consulting (Valencia, Spain) for their support during the writing process.

Ethical approval

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of Reina Sofía Hospital (code TFM-CDIF-2019, date of approval 23 December 2019).

Author’s contributions

BG and JMB were responsible for the conception and design of the study, data collection, data interpretation, writing the manuscript and final version approval. PS made a substantial contribution with the study data acquisition. MC contributed with data acquisition and methodology. All the authors approved the final version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data underlying this article will be shared on reasonable request to the corresponding author.

Additional information

Funding

This study was not supported by any institution. BG obtained a publication grant funded by GETECCU.