title: Antibiotics for Treatment of Clostridium difficile Infection in Hospitalized Patients with Inflammatory Bowel Disease.
abstract: Patients with inflammatory bowel disease (IBD), namely ulcerative colitis (UC) and Crohn's disease (CD), have worse outcomes with Clostridium difficile infection (CDI), including increased readmissions, colectomy, and death. Oral vancomycin is recommended for the treatment of severe CDI, while metronidazole is the standard of care for nonsevere infection. We aimed to assess treatment outcomes of CDI in IBD. We conducted a retrospective observational study of inpatients with CDI and IBD from January 2006 through December 2010. CDI severity was assessed using published criteria. Outcomes included readmission for CDI within 30 days and 12 weeks, length of stay, colectomy, and death. A total of 114 patients met inclusion criteria (UC, 62; CD, 52). Thirty-day readmissions were more common among UC than CD patients (24.2% versus 9.6%; P=0.04). Same-admission colectomy occurred in 27.4% of UC patients and 0% of CD patients (P<0.01). Severe CDI was more common among UC than CD patients (32.2% versus 19.4%; P=0.12) but not statistically significant. Two patients died from CDI-associated complications (UC, 1; CD, 1). Patients with UC and nonsevere CDI had fewer readmissions and shorter lengths of stay when treated with a vancomycin-containing regimen compared to those treated with metronidazole (30-day readmissions, 31.0% versus 0% [P=0.04]; length of stay, 13.62 days versus 6.38 days [P=0.02]). Patients with UC and nonsevere CDI have fewer readmissions and shorter lengths of stay when treated with a vancomycin-containing regimen relative to those treated with metronidazole alone. Patients with ulcerative colitis and CDI should be treated with vancomycin.
authors.affiliation: F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Institute, Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Horton
authors.affiliation: F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Institute, Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Seper
authors.initials: S
authors.lastname: Dezfoli
authors.affiliation: F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Institute, Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Dror
authors.initials: D
authors.lastname: Berel
authors.affiliation: F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Institute, Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Julianna
authors.initials: J
authors.lastname: Hirsch
authors.affiliation: F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Institute, Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ippoliti
authors.affiliation: F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Institute, Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Dermot
authors.initials: D
authors.lastname: McGovern
authors.affiliation: F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Institute, Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Manreet
authors.initials: M
authors.lastname: Kaur
authors.affiliation: F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Institute, Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: David
authors.initials: D
authors.lastname: Shih
authors.affiliation: Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Marla
authors.initials: M
authors.lastname: Dubinsky
authors.affiliation: F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Institute, Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Stephan R
authors.initials: SR
authors.lastname: Targan
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Fleshner
authors.affiliation: F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Institute, Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Vasiliauskas
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA Department of Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Grein
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA Department of Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Rekha
authors.initials: R
authors.lastname: Murthy
authors.affiliation: F. Widjaja Foundation, Inflammatory Bowel and Immunobiology Institute, Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA melmedg@cshs.org.
authors.forename: Gil Y
authors.initials: GY
authors.lastname: Melmed
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000187:drug effects*; D003015:Clostridium Infections / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000382:microbiology*; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014640:Vancomycin