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P655 Incidence and risk factors of Clostridium difficile infection in patients with inflammatory bowel disease

O. Stoica1, A. Trifan*1, C. Cojocariu1, A.-M. Singeap1, I. Girleanu1, R. Maxim1, C. Stanciu2

1University of Medicine and Pharmacy "Gr. T Popa ", Iasi, Institute of Gastroenterology and Hepatology, Iasi, Romania, 2Institute of Gastroenterology and Hepatology, Bd. Independentei, no. 1, Gastroenterology and Hepatology, Iasi, Romania

Background

Clostridium difficile infection (CDI) increases mortality, incidence and disease severity in hospitalized patients worldwide. Recent changes in the epidemiology of CDI include the identification of patients with inflammatory bowel disease (IBD) as a group at risk in comparison to the general population. The aim of this study was to identify the incidence and risk factors for CDI among patients with inflammatory bowel disease.

Methods

We performed a case-control study including 78 patients diagnosed with IBD hospitalized at the Institute of Gastroenterology and Hepatology in Iasi, Romania, between January 2012-July 2014. Demographic data and clinical characteristics were reviewed. IBD patients who had positive results for C. difficile toxins A and B were matched by sex, age and type of IBD with IBD patients hospitalized in the same period of time who had negative C. difficile toxins.

Results

Both groups were comparable for baseline characteristics. Out of the 78 patients diagnosed with IBD included in the study, C. difficile was detected in 26 patients (33.33%). The annual incidence of CDI in patients with IBD increased from 2.01% in 2012 to 16% in 2014. There was no statistical difference regarding hospitalization days (10.42 ± 7.34 vs. 8.01 ± 6.14, p=0.129) between the two study groups. Risk factors for CDI in patients with IBD were: ulcerative colitis (OR=1.90, CI= 1.320-2.720; p=0.001), use of proton pump inhibitors (OR=1.57, CI= 1.133-2.032; p=0.012), previous antibiotic use (OR=2.3, CI=1.587-3.332; p<0.0001), and albumin<3g/dl (OR=1.78, CI=1.023-5.558; p=0.038). Immunosuppressive and anti TNF- α treatment were not risk factors for C. difficile development in patients with IBD.

Conclusion

CDI in patients with IBD is a serious infection and should be treated aggressively with close clinical follow-up. Ulcerative colitis, previous treatment with antibiotics and proton pump inhibitors represent risk factors for CDI development in patients with IBD.