title: Clostridium difficile and inflammatory bowel disease: role in pathogenesis and implications in treatment.
abstract: Clostridium difficile (C. difficile) is the leading cause of antibiotic associated colitis and nosocomial diarrhea. Patients with inflammatory bowel disease (IBD) are at increased risk of developing C. difficile infection (CDI), have worse outcomes of CDI-including higher rates of colectomy and death, and experience higher rates of recurrence. However, it is still not clear whether C. difficile is a cause of IBD or a consequence of the inflammatory state in the intestinal environment. The burden of CDI has increased dramatically over the past decade, with severe outbreaks described in many countries, which have been attributed to a new and more virulent strain. A parallel rise in the incidence of CDI has been noted in patients with IBD. IBD patients with CDI tend be younger, have less prior antibiotic exposure, and most cases of CDI in these patients represent outpatient acquired infections. The clinical presentation of CDI in these patients can be unique-including diversion colitis, enteritis and pouchitis, and typical findings on colonoscopy are often absent. Due to the high prevalence of CDI in patients hospitalized with an IBD exacerbation, and the prognostic implications of CDI in these patients, it is recommended to test all IBD patients hospitalized with a disease flare for C. difficile. Treatment includes general measures such as supportive care and infection control measures. Antibiotic therapy with either oral metronidazole, vancomycin, or the novel antibiotic-fidaxomicin, should be initiated as soon as possible. Fecal macrobiota transplantation constitutes another optional treatment for severe/recurrent CDI. The aim of this paper is to review recent data on CDI in IBD: role in pathogenesis, diagnostic methods, optional treatments, and outcomes of these patients.
authors.affiliation: Orna Nitzan, Bibiana Chazan, Raul Raz, Infectious Disease Unit, Ha'emek Medical Center, Afula 18101, Israel.
authors.forename: Orna
authors.initials: O
authors.lastname: Nitzan
authors.forename: Mazen
authors.initials: M
authors.lastname: Elias
authors.forename: Bibiana
authors.initials: B
authors.lastname: Chazan
authors.forename: Raul
authors.initials: R
authors.lastname: Raz
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001691:Biological Therapy; D016360:Clostridioides difficile / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity*; D018450:Disease Progression; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology* / Q000628:therapy; D005243:Feces / Q000382:microbiology; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology* / Q000628:therapy; D007422:Intestines / Q000276:immunology / Q000382:microbiology*; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome; D014774:Virulence
chemical_list: D000900:Anti-Bacterial Agents
keywords: Clostridium difficile; Diarrhea; Inflammatory bowel disease; Pathogenesis; Treatment