Horton Henry A, Dezfoli Seper, Berel Dror, Hirsch Julianna, Ippoliti Andrew, McGovern Dermot, Kaur Manreet, Shih David, Dubinsky Marla, Targan Stephan R, Fleshner Phillip, Vasiliauskas Eric A, Grein Jonathan, Murthy Rekha, Melmed Gil Y
F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Institute, Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Antimicrob Agents Chemother. 2014 Sep;58(9):5054-9. doi: 10.1128/AAC.02606-13. Epub 2014 Jun 9.
Patients with inflammatory bowel disease (IBD), namely ulcerative colitis (UC) and Crohn's disease (CD), have worse outcomes with Clostridium difficile infection (CDI), including increased readmissions, colectomy, and death. Oral vancomycin is recommended for the treatment of severe CDI, while metronidazole is the standard of care for nonsevere infection. We aimed to assess treatment outcomes of CDI in IBD. We conducted a retrospective observational study of inpatients with CDI and IBD from January 2006 through December 2010. CDI severity was assessed using published criteria. Outcomes included readmission for CDI within 30 days and 12 weeks, length of stay, colectomy, and death. A total of 114 patients met inclusion criteria (UC, 62; CD, 52). Thirty-day readmissions were more common among UC than CD patients (24.2% versus 9.6%; P=0.04). Same-admission colectomy occurred in 27.4% of UC patients and 0% of CD patients (P<0.01). Severe CDI was more common among UC than CD patients (32.2% versus 19.4%; P=0.12) but not statistically significant. Two patients died from CDI-associated complications (UC, 1; CD, 1). Patients with UC and nonsevere CDI had fewer readmissions and shorter lengths of stay when treated with a vancomycin-containing regimen compared to those treated with metronidazole (30-day readmissions, 31.0% versus 0% [P=0.04]; length of stay, 13.62 days versus 6.38 days [P=0.02]). Patients with UC and nonsevere CDI have fewer readmissions and shorter lengths of stay when treated with a vancomycin-containing regimen relative to those treated with metronidazole alone. Patients with ulcerative colitis and CDI should be treated with vancomycin.
患有炎症性肠病（IBD），即溃疡性结肠炎（UC）和克罗恩病（CD）的患者，在艰难梭菌感染（CDI）时预后更差，包括再入院率增加、结肠切除术和死亡率升高。口服万古霉素被推荐用于治疗严重CDI，而甲硝唑是治疗非严重感染的标准疗法。我们旨在评估IBD患者中CDI的治疗结果。我们对2006年1月至2010年12月期间患有CDI和IBD的住院患者进行了一项回顾性观察研究。使用已发表的标准评估CDI的严重程度。结果包括30天和12周内CDI再入院情况、住院时间、结肠切除术和死亡率。共有114名患者符合纳入标准（UC患者62例；CD患者52例）。UC患者30天再入院率比CD患者更常见（24.2%对9.6%；P = 0.04）。同一住院期间结肠切除术在27.4%的UC患者中发生，而在CD患者中为零（P < 0.01）。严重CDI在UC患者中比CD患者更常见（32.2%对19.4%；P = 0.12），但无统计学意义。两名患者死于CDI相关并发症（UC患者1例；CD患者1例）。与接受甲硝唑治疗的患者相比，接受含万古霉素方案治疗的UC和非严重CDI患者再入院次数更少，住院时间更短（30天再入院率，31.0%对0% [P = 0.04]；住院时间，13.62天对6.38天 [P = 0.02]）。相对于仅接受甲硝唑治疗的患者，接受含万古霉素方案治疗的UC和非严重CDI患者再入院次数更少，住院时间更短。患有溃疡性结肠炎和CDI的患者应以万古霉素治疗。
