Stoica Oana, Trifan Anca, Cojocariu Camelia, Gîrleanu Irina, Maxim Roxana, Stanciu Maxim C
Rev Med Chir Soc Med Nat Iasi. 2015 Jan-Mar;119(1):81-6.
Recent changes in the epidemiology of Clostridium difficile infection (CDI) include the identification of patients with inflammatory bowel disease (IBD) as a group at risk in comparison to the general population.
To identify the incidence and risk factors for CDI among patients with IBD.
Case-control study of 78 patients diagnosed with IBD, hospitalized at the Iasi Institute of Gastroenterology and Hepatology between January 2012 and -July 2014. Demographic data and clinical characteristics were reviewed for all patients. IBD patients with positive C. difficile toxins A and B tests were matched by sex, age and type of IBD with IBD patients hospitalized in the same period with negative C. difficile toxins tests.
Both groups were comparable for baseline characteristics. Of the 78 patients diagnosed with IBD included in the study, C. difficile was detected in 26 patients (33.33%). There was no statistical difference regarding length of hospital stay (10.42 ± 7.34 vs. 8.01 ± 16.14 days, 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 < 3 g/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.
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.
艰难梭菌感染（CDI）流行病学的近期变化包括，与普通人群相比，已将炎症性肠病（IBD）患者确定为有风险的一组人群。
确定IBD患者中CDI的发病率及风险因素。
对2012年1月至2014年7月间在雅西胃肠病学和肝病研究所住院的78例确诊为IBD的患者进行病例对照研究。回顾了所有患者的人口统计学数据和临床特征。艰难梭菌毒素A和B检测呈阳性的IBD患者，按性别、年龄和IBD类型与同期住院的艰难梭菌毒素检测呈阴性的IBD患者进行匹配。
两组患者的基线特征具有可比性。在纳入研究的78例确诊为IBD的患者中，26例（33.33%）检测到艰难梭菌。两个研究组之间的住院时间无统计学差异（10.42±7.34天对8.01±16.14天，p = 0.129）。IBD患者发生CDI的风险因素为：溃疡性结肠炎（比值比[OR]=1.90，可信区间[CI]=1.320 - 2.720，p = 0.001）、使用质子泵抑制剂（OR = 1.57，CI = 1.133 - 2.032，p = 0.012）、既往使用过抗生素（OR = 2.3，CI = 1.587 - 3.332，p < 0.0001）以及白蛋白<3 g/dl（OR = 1.78，CI = 1.023 - 5.558，p = 0.038）。免疫抑制治疗和抗TNF-α治疗不是IBD患者发生艰难梭菌感染的风险因素。
IBD患者的CDI是一种严重感染，应积极治疗并密切临床随访。溃疡性结肠炎、既往使用抗生素和质子泵抑制剂是IBD患者发生CDI的风险因素。
