Department of Internal Medicine, McGill University Health Center, Montreal, QC, Canada.
Division of Gastroenterology, Montreal General Hospital, McGill University Health Center, Montreal, QC, Canada.
J Crohns Colitis. 2019 Jan 1;13(1):27-38. doi: 10.1093/ecco-jcc/jjy143.
Clostridium difficile infection [CDI] is a significant concern in inflammatory bowel disease [IBD]. Risk factors and consequences associated with CDI in inflammatory bowel disease [IBD] patients are important to characterize. The aim of this research was to perform a systematic review and meta-analysis on risk factors and outcomes associated with CDI in IBD patients.
Multiple databases were searched for studies investigating risk factors, colectomy and mortality risk in IBD patients with and without CDI. This was stratified by short [<3 months] and long-term [>1 year] outcomes. Summary estimates were calculated using a random-effects model. Quality assessment used the Newcastle-Ottawa scale.
Twenty-two studies met inclusion criteria. Antibiotics use within 30 days of diagnosis was associated with CDIs (odds ratio [OR]: 1.85, 95% confidence interval [CI]:1.36, 2.52). Colonic involvement in Crohn's disease patients was associated with significantly higher CDI rates [OR: 2.76, 95% CI: 1.75, 4.35]. There was a significant association between biologic medication use and CDI [OR: 1.65, 95% CI: 1.18, 2.30], with minimal heterogeneity [I2 = 4.0%]. The long-term colectomy risk was significantly higher for IBD patients with CDI compared with that for IBD patients without CDI [OR: 2.22, 95% CI: 1.17, 4.18]. Significantly higher mortality was found for CDI in IBD patients both short-term [OR: 3.84, 95% CI: 2.62, 5.61] and long-term [OR: 3.65, 95% CI: 1.58, 8.44]. Substantial heterogeneity existed. Most studies were of moderate quality.
Colonic involvement, and biologic and antibiotic use appear to be risk factors associated with CDI among IBD patients. CDI is associated with increased short- and long-term mortality.
艰难梭菌感染（CDI）是炎症性肠病（IBD）的一个重要关注点。与 IBD 患者 CDI 相关的风险因素和后果对于疾病的特征描述非常重要。本研究旨在对 IBD 患者 CDI 的相关风险因素和结果进行系统评价和荟萃分析。
对多个数据库进行检索，以确定研究 IBD 患者中与 CDI 相关的风险因素、结肠切除术和死亡率的研究。该研究根据短期（<3 个月）和长期（>1 年）结局进行分层。使用随机效应模型计算汇总估计值。使用纽卡斯尔-渥太华量表进行质量评估。
共有 22 项研究符合纳入标准。诊断后 30 天内使用抗生素与 CDI 相关（比值比 [OR]：1.85，95%置信区间 [CI]：1.36，2.52）。克罗恩病患者的结肠受累与更高的 CDI 发生率显著相关（OR：2.76，95%CI：1.75，4.35）。生物药物的使用与 CDI 之间存在显著关联（OR：1.65，95%CI：1.18，2.30），异质性较小（I2=4.0%）。与无 CDI 的 IBD 患者相比，有 CDI 的 IBD 患者的长期结肠切除术风险显著更高（OR：2.22，95%CI：1.17，4.18）。CDI 导致 IBD 患者的短期（OR：3.84，95%CI：2.62，5.61）和长期（OR：3.65，95%CI：1.58，8.44）死亡率均显著升高。存在大量异质性。大多数研究的质量为中等。
结肠受累以及生物制剂和抗生素的使用似乎是 IBD 患者 CDI 的相关风险因素。CDI 与短期和长期死亡率增加相关。
