Department of Medicine, New York Presbyterian Columbia University Medical Center, 630 West 168th Street, New York, NY, 10032, USA.
Division of Digestive and Liver Diseases, Department of Medicine, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, NY, 10032, USA.
Dig Dis Sci. 2021 Sep;66(9):3113-3123. doi: 10.1007/s10620-020-06504-y. Epub 2020 Jul 29.
Inflammatory bowel disease (IBD) patients who have Clostridioides difficile infection (CDI) have worse outcomes.
We aimed to determine whether such outcomes are the result of CDI or whether CDI occurs in patients who have more severe IBD.
This was a retrospective study of patients hospitalized for ≥ 2 IBD flares from 2010 to 2019. The primary outcome was time to IBD flare between hospitalizations. First, time to flare was compared between patients who were hospitalized for a flare complicated by CDI and subsequently for a CDI-negative flare (cohort A, denoted +/-) versus patients who were hospitalized for two CDI-negative flares (cohort B, -/-). Second, time between flares was compared within the subset of cohort A patients who had three flares (cohort C, -/+/-) before and after CDI.
Time between flares was a median of 4 months (IQR 1-9) among 51 cohort A patients versus 12 months (IQR 6-38) among 51 cohort B patients (log-rank P < 0.01). In contrast, the median time between flares was similar within cohort C before and after CDI (log-rank P = 0.54). At time of the second IBD flare, patients in cohort A (+/-) were more likely to have moderate or severe disease compared to patients in cohort B (-/-).
Patients with prior CDI had shorter time to subsequent IBD flare relative to their CDI-negative counterparts. This is not likely due to CDI itself because there was no difference in time between flares before versus after acquiring CDI. Rather, patients who acquire CDI may have more severe IBD.
患有艰难梭菌感染（CDI）的炎症性肠病（IBD）患者预后更差。
我们旨在确定这些结果是由 CDI 引起的，还是 CDI 发生在病情更严重的 IBD 患者中。
这是一项回顾性研究，纳入了 2010 年至 2019 年期间因≥2 次 IBD 发作而住院的患者。主要结局是两次住院之间 IBD 发作的时间。首先，将因 CDI 并发的 IBD 发作而住院随后因 CDI 阴性发作（队列 A，记为 +/-）的患者与因两次 CDI 阴性发作（队列 B，-/-）的患者的发作时间进行比较。其次，在队列 A 中，比较了在 CDI 之前和之后有三次发作（队列 C，-/+/-）的患者的发作之间的时间。
51 例队列 A 患者的两次发作之间的时间中位数为 4 个月（IQR 1-9），51 例队列 B 患者的两次发作之间的时间中位数为 12 个月（IQR 6-38）（对数秩 P < 0.01）。相比之下，在 CDI 前后，队列 C 内的两次发作之间的时间中位数相似（对数秩 P = 0.54）。在第二次 IBD 发作时，与队列 B 患者（-/-）相比，队列 A（ +/-）患者更可能患有中度或重度疾病。
与 CDI 阴性对照相比，先前患有 CDI 的患者发生后续 IBD 发作的时间更短。这可能不是由于 CDI 本身引起的，因为在获得 CDI 之前和之后，发作之间的时间没有差异。相反，患有 CDI 的患者可能患有更严重的 IBD。
