Risk factors and clinical outcome of Clostridium difficile infection in patients with IBD: A single-center retrospective study of 260 cases in China

OBJECTIVE: Clostridium difficile infection (CDI) may lead to poor outcomes in patients with inflammatory bowel disease (IBD). In this study we aimed to investigate the cumulative incidence, risk factors and outcome of CDI in patients with IBD in a single center in China. METHODS: The clinical features and endoscopic profiles of consecutive IBD patients admitted to Ruijin Hospital, Shanghai Jiaotong University School of Medicine between January 2013 and December 2015 were retrospectively analyzed. CDI was diagnosed based on a positive polymerase chain reaction (PCR) stool test. RESULTS: A total of 260 patients with IBD were enrolled, including 176 with Crohn's disease (CD) and 84 with ulcerative colitis (UC). Altogether 13 (5.0%) patients were diagnosed with CDI. The incidence of CDI was 4.0% (7/176) in CD and 7.1% (6/84) in UC, respectively. The endoscopic feature of pseudomembrane was found in four (33.3%) IBDCDI patients, and pseudomembrane and deep ulcers were significantly correlated with CDI (P < 0.001 and P = 0.006, respectively). Hemoglobin (Hb) < 100 g/L was found to be associated with CDI (OR 3.48, 95% CI 1.04-11.61, P = 0.043). Patients in the CDI group showed a higher risk of developing abdominal abscesses than those in the non-CDI group (OR 6.09, 95% CI 1.8-15.2, P = 0.003). CONCLUSIONS: PCR-based fecal test for CDI should be performed in these IBD patients. Hb < 100 g/L may be an important risk factor for CDI in IBD. For patients with CDI, antibiotics should be administered promptly to prevent abdominal abscess.