Vaughn Byron P, Khoruts Alexander, Fischer Monika
Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA .
Am J Gastroenterol. 2025 Feb 1;120(2):313-319. doi: 10.14309/ajg.0000000000003076. Epub 2024 Sep 4.
Patients with inflammatory bowel disease (IBD) have an increased risk of Clostridioides difficile infection (CDI), which can lead to worse IBD outcomes. The diagnosis of CDI in patients with IBD is complicated by higher C. difficile colonization rates and shared clinical symptoms of intestinal inflammation. Traditional risk factors for CDI, such as antibiotic exposure, may be lacking in patients with IBD because of underlying intestinal microbiota dysbiosis. Although CDI disproportionately affects people with IBD, patients with IBD are typically excluded from CDI clinical trials creating a knowledge gap in the diagnosis and management of these 2 diseases. This narrative review aims to provide a comprehensive overview of the diagnosis, treatment, and prevention of CDI in patients with IBD. Distinguishing CDI from C. difficile colonization in the setting of an IBD exacerbation is important to avoid treatment delays. When CDI is diagnosed, extended courses of anti- C. difficile antibiotics may lead to better CDI outcomes. Regardless of a diagnosis of CDI, the presence of C. difficile in a patient with IBD should prompt a disease assessment of the underlying IBD. Microbiota-based therapies and bezlotoxumab seem to be effective in preventing CDI recurrence in patients with IBD. Patients with IBD should be considered at high risk of CDI recurrence and evaluated for a preventative strategy when diagnosed with CDI. Ultimately, the comanagement of CDI in a patient with IBD requires a nuanced, patient-specific approach to distinguish CDI from C. difficile colonization, prevent CDI recurrence, and manage the underlying IBD.
炎症性肠病（IBD）患者发生艰难梭菌感染（CDI）的风险增加，这可能导致IBD的预后更差。IBD患者中CDI的诊断因艰难梭菌定植率较高以及肠道炎症的共同临床症状而变得复杂。由于潜在的肠道微生物群失调，IBD患者可能缺乏CDI的传统风险因素，如抗生素暴露。尽管CDI对IBD患者的影响尤为严重，但IBD患者通常被排除在CDI临床试验之外，这在这两种疾病的诊断和管理方面造成了知识空白。本叙述性综述旨在全面概述IBD患者CDI的诊断、治疗和预防。在IBD病情加重的情况下，区分CDI与艰难梭菌定植对于避免治疗延误很重要。当诊断为CDI时，延长疗程的抗艰难梭菌抗生素可能会带来更好的CDI治疗效果。无论是否诊断为CDI，IBD患者中存在艰难梭菌都应促使对潜在的IBD进行病情评估。基于微生物群的疗法和贝佐妥单抗似乎在预防IBD患者CDI复发方面有效。IBD患者应被视为CDI复发的高危人群，在诊断为CDI时应评估预防策略。最终，IBD患者CDI的联合管理需要一种细致入微、针对患者的方法，以区分CDI与艰难梭菌定植、预防CDI复发并管理潜在的IBD。
