title: Impact of Clostridium difficile infection in patients with ulcerative colitis.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) is becoming prevalent in general population as well as in patients with inflammatory bowel disease (IBD).
  
  
  OBJECTIVE
  The aim of the study was to identify risk factors for CDI in patients with ulcerative colitis (UC) and to assess outcome of UC in patients following CDI.
  
  
  METHODS
  UC inpatients or outpatients who had positive results for C. difficile toxins A and B between 2000 and 2006 were identified (N=39) and matched for age and gender to UC patients who were negative C. difficile toxins and had never been diagnosed with CDI (N=39). Records were reviewed for adverse clinical outcome, defined as colectomy within 3 months of C. difficile testing. Conditional logistic regression was used to analyze multivariable association to identify risk factors for CDI and for adverse clinical outcome.
  
  
  RESULTS
  A total of 78 subjects were analyzed, 60% were males. Median age was 39. Among 39 patients with CDI, 20 (47.2%) were diagnosed as outpatients, 50% failed treatment with the first antibiotic monotherapy, and 21.2% had recurrent infection. Antibiotic exposure within 30 days prior to C. difficile testing was found to be associated with an increased risk for CDI with an odds ratio of 12.0 (95% CI 1.2, 124.2) Subsequent colectomy within 3 months after CDI diagnosis, was not associated with CDI in both univariable and multivariable analyses. After adjusting for CDI, lack of 5-aminosalicylic acid (ASA) in the treatment regimen was significantly associated with colectomy with an odds ratio of 3.3 (95% CI: 1.2, 9.4). There was no UC- or CDI-associated mortality in this case series.
  
  
  CONCLUSIONS
  Recent antibiotic exposure was a risk factor for CDI in UC patients. Interestingly, CDI does not seem to adversely affect short-term adverse clinical outcome (colectomy).
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Revital
authors.initials: R
authors.lastname: Kariv
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.forename: Preethi G K
authors.initials: PG
authors.lastname: Venkatesh
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000328:Adult; D001426:Bacterial Proteins / Q000378:metabolism; D001427:Bacterial Toxins / Q000378:metabolism; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D016360:Clostridioides difficile; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000150:complications* / Q000382:microbiology / Q000601:surgery; D016001:Confidence Intervals; D004761:Enterocolitis, Pseudomembranous / Q000150:complications*; D004768:Enterotoxins / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile