How Clostridium difficile Impacts IBD

Two decades ago, CDI was considered uncommon among IBD patients, even among those presenting with a disease flare up. In fact, some studies questioned the relevance of routinely looking for C difficileas an inciting pathogen among patients with an IBD flare up. More recently, published literature has confirmed a rising incidence and excess morbidity and mortality associated with CDI in IBD patients. Research has shown that IBD patients with colitis appear to be at greater risk for acquiring CDI. These individuals are at greater risk for poor clinical outcomes, including colectomy and death, when compared with the general population. In addition, CDI has been associated with a significant increase in healthcare utilization and costs. Length of hospitalization has been identified as a risk factor for acquisition of C difficile. CDI itself may be associated with a 40% to 60% increase in length-of-stay and hospitalization costs. In a recent analysis, my colleagues and I found that CDI is associated with a 3-day excess hospitalization stay and more than $11,000 in hospitalization charges. “It’s important for treating clinicians to have a high suspicion index for CDI in IBD patients.”  Treatment Challenges Persist Older age and comorbidity are well-recognized risk factors for CDI, but we now have several reports of CDI among younger, healthy outpatients. Both CDI and IBD flares often present with similar symptoms but have markedly divergent management plans. When IBD is present and immunosuppressive drugs are required, it can be challenging to achieve an immunologic response to C difficile toxins. This is important because it may represent a critical mechanism for eradicating CDI and establishing stable colonization. Treatment of CDI in IBD requires directed...