title: Low risk of Clostridium difficile infections in hospitalized patients with inflammatory bowel disease in a German tertiary referral center.
abstract: BACKGROUND
  Many reports, mainly from the US and Canada but also a recent report from a center in Europe, have documented the increasing impact of Clostridium difficile infections in patients with inflammatory bowel disease (IBD) during the last years. To determine the prevalence of C. difficile infections in hospitalized IBD patients in a tertiary referral center in Germany, we conducted this retrospective analysis.
  
  
  METHODS
  Data of all IBD in-patients treated due to an acute flare of their IBD at the Department of Internal Medicine I of the University of Regensburg between January 1, 2001, and June 30, 2008, were analyzed. In patients with a concomitant diagnosis of C. difficile infection, further variables such as IBD-related treatment at the time of infection or outcome were examined.
  
  
  RESULTS
  In total, 995 in-patients with IBD were treated in this hospital [638 patients with Crohn's disease (CD), 357 with ulcerative colitis (UC)] during the study period. Of these, 279 patients with CD and 242 patients with UC were admitted with an acute flare and suffering from diarrhea and abdominal pain. Only 10 of those were diagnosed as having a concomitant infection with C. difficile. Six patients were female and the median age was 49 years (range: 15-80). Six patients with C. difficile infections suffered from UC and 4 patients from CD, all with previous colonic involvement. Eight patients used immunosuppressive therapies; only 2 patients were treated with antibiotics before infection.
  
  
  CONCLUSIONS
  In contrast to recent reports from other countries, only a low percentage of hospitalized patients with acute flares of their IBD were identified as having an underlying C. difficile infection in this German tertiary referral center. However, in IBD patients with an acute flare, a concomitant C. difficile infection should be excluded, especially in patients with immunosuppressive treatment and colonic involvement of their disease. Further research is needed to evaluate if regions with different risks of C. difficile infections exist and to find out more about potential reasons for this observation.
authors.affiliation: Department of Internal Medicine I, University of Regensburg, Regensburg, Germany. claudia.ott@klinik.uni-r.de
authors.forename: Claudia
authors.initials: C
authors.lastname: Ott
authors.forename: Christiane
authors.initials: C
authors.lastname: Girlich
authors.forename: Frank
authors.initials: F
authors.lastname: Klebl
authors.forename: Annelie
authors.initials: A
authors.lastname: Plentz
authors.forename: Igors
authors.initials: I
authors.lastname: Iesalnieks
authors.forename: Jürgen
authors.initials: J
authors.lastname: Schölmerich
authors.forename: Florian
authors.initials: F
authors.lastname: Obermeier
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D003093:Colitis, Ulcerative / Q000150:complications* / Q000188:drug therapy; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000890:Anti-Infective Agents; D007166:Immunosuppressive Agents; D008795:Metronidazole; D001379:Azathioprine