title: Clostridium difficile infection is associated with worse long term outcome 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 investigate the long-term impact of CDI in patients with ulcerative colitis (UC).
  
  
  METHODS
  UC inpatients or outpatients who had positive results for stool C. difficile toxins A and B between 2002 and 2007 were identified (N=45). The 45 patients were matched for age and gender to UC patients who were negative for C. difficile and had never been diagnosed with CDI (N=101). The primary Colectomy within 12 months of C. difficile testing was the primary outcome patients with CDI and no-CDI.
  
  
  RESULTS
  Forty-five patients were CDI positive and 101 were negative. Patients who were CDI positive had significantly more UC-related emergency room visits in the year following initial infection (37.8% vs. 4%, p<0.001) than those without CDI. One year following the index infection admission, CDI patients also had a significantly higher rate of colectomy than controls (35.6% vs. 9.9%, p<0.001). Among patients with CDI, 55.8% of patients had an escalation in medical treatment in the year after CDI as compared to the prior year of 12.9%, p<0.0001. CDI (odds ratio (OR) 10.0, 95% confidence interval CI: 2.7, 36.3, p<0.001) and severe disease on endoscopy (OR 16.7, 95% (CI): 4.1, 67.9, p<0.001) were found to be independently associated with colectomy within 1 year on logistic regression analyses.
  
  
  CONCLUSIONS
  CDI appears to be associated with escalation of medical therapy in the year following infection. CDI and severe disease on endoscopy appear to be associated with an increased risk for subsequent colectomy on long-term follow up.
authors.affiliation: Digestive disease Institute, The Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.forename: Saurabh
authors.initials: S
authors.lastname: Mukewar
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; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001427:Bacterial Toxins / Q000032:analysis*; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000150:complications* / Q000382:microbiology; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000150:complications* / Q000188:drug therapy / Q000601:surgery*; D016001:Confidence Intervals; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D016099:Endoscopy, Gastrointestinal; D005243:Feces / Q000737:chemistry; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000893:Anti-Inflammatory Agents; D001427:Bacterial Toxins; D011241:Prednisone