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P745 Clostridium difficile infection in inflammatory bowel disease patients: prevalence and risk factors

M. Su, H. Chen, M. Zhi*, H. He, M. Zhang, J. Tang, J. Hu, Y. Zhang, N. Ding, L. Ma, H. Chen, X. Gao, P. Hu

The Sixth Affiliated Hospital of Sun Yat-sen University, Department of Gastroenterology, Guangzhou, China

Background

There has been a remarkable rise in the incidence of Clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD). However, prospective studies addressing CDI remained scarce. The aim of this work was to investigate the prevalence and risk factors of CDI in IBD patients in China.

Methods

Faecal samples were obtained from 250 patients that were diagnosed with Crohn’s disease (CD, n = 166) or ulcerative colitis (UC, n = 84) at the IBD centre of a tertiary hospital in China between March and December 2014, and 112 controls comprising functional gastrointestinal disorder patients and healthy individuals. Enzyme immunoassays, PCR-fluorescence probe assays, and real-time PCR assays were employed to detect Toxin A and B or their encoding genes. Statistical analyses were performed using SPSS software. To identify CDI risk factors, variables such as age, gender, smoking, disease activity, colonic involvement, CDI detection within 3 days of hospitalisation, prior hospitalisation, severe coexisting diseases, and use of antibiotics, immunomodulators, or biologics 2 months before hospitalisation were subjected to univariate and multivariate logistic regression analyses. A p-value of < 0.05 was considered statistically significant, and in-hospital mortality was regarded as a prognostic indicator.

Results

The overall CDI rate of the IBD group was significantly higher than that of the control group (12.8% vs 3.57%, p = 0.007). The CD sub-group exhibited a slightly lower CDI rate than the UC patients (10.8% vs 16.7%, p = 0.193), although the difference was not statistically significant. Amongst the variables examined, only use of antibiotics before hospitalisation was revealed to significantly increase the incidence of CDI in all IBD patients enrolled in this study (p < 0.001), and multivariate analyses further defined it as an independent risk factor (OR = 4.032; 95%CI = 1.873–8.680, p < 0.001). Upon univariate logistic regression analyses of the UC sub-group, ≥ 3 days of hospital stay (p = 0.003), use of antibiotics (p < 0.001), and use of immunomodulators (p = 0.022) were identified as CDI risk factors, whereas only the first 2 were found predictive of CDI, with odd ratios of 6.365 (95% CI = 1.509–26.848, p = 0.012) and 12.537 (95%CI = 3.008–52.249, P = 0.001) respectively. For the CD patients, none of the variables assessed qualified as a relevant CDI risk factor using either univariate or multivariate analyses. No death occurred during our study.

Conclusion

A significant fraction of IBD patients in China, particularly those with active UC, are burdened with CDI. Hospitalized for ≥ 3 days and use of antibiotics or immunomodulators may predict higher risk of CDI for UC patients.