title: Prevalence and risk factors of Clostridium difficile infection in patients hospitalized for flare of inflammatory bowel disease: a retrospective assessment.
abstract: BACKGROUND
  Recent studies have identified a high frequency of Clostridium difficile infections in patients with active inflammatory bowel disease.
  
  
  OBJECTIVE
  To retrospectively assess the determinants and results of Clostridium difficile testing upon the admission of patients hospitalized with active inflammatory bowel disease in a tertiary care centre and to determine the predicting factors of Clostridium difficile infections.
  
  
  METHODS
  We reviewed all admissions from January 2008 and December 2010 for inflammatory bowel disease flare-ups. A toxigenic culture and a stool cytotoxicity assay were performed for all patients tested for Clostridium difficile.
  
  
  RESULTS
  Out of 813 consecutive stays, Clostridium difficile diagnostic assays have been performed in 59% of inpatients. The independent predictive factors for the testing were IBD (ulcerative colitis: OR 2.0, 95% CI 1.5-2.9; p<0.0001) and colonic involvement at admission (OR 2.2, 95% CI 1.5-3.1, p<0.0001). Clostridium difficile infection was present in 7.0% of the inpatients who underwent testing. In a multivariate analysis, the only independent predictor was the intake of nonsteroidal anti-inflammatory drugs within the two months before admission (OR 3.8, 95% CI 1.2-12.3; p=0.02).
  
  
  CONCLUSIONS
  Clostridium difficile infection is frequently associated with active inflammatory bowel disease. Our study suggests that a recent intake of nonsteroidal anti-inflammatory drugs is a risk factor for inflammatory bowel disease -associated Clostridium difficile infection.
authors.affiliation: Department of Gastroenterology, APHP, Saint-Antoine Hospital, Paris, France. Electronic address: helene.regnault@psl.aphp.fr.
authors.forename: Helene
authors.initials: H
authors.lastname: Regnault
authors.affiliation: Department of Gastroenterology, APHP, Saint-Antoine Hospital, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Bourrier
authors.affiliation: Department of Microbiology, APHP, Saint-Antoine Hospital, Paris, France.
authors.forename: Valerie
authors.initials: V
authors.lastname: Lalande
authors.affiliation: Department of Gastroenterology, APHP, Saint-Antoine Hospital, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Nion-Larmurier
authors.affiliation: Department of Gastroenterology, APHP, Saint-Antoine Hospital, Paris, France.
authors.forename: Harry
authors.initials: H
authors.lastname: Sokol
authors.affiliation: Department of Gastroenterology, APHP, Saint-Antoine Hospital, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Seksik
authors.affiliation: National Reference Laboratory for C. difficile, Paris, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Barbut
authors.affiliation: Department of Gastroenterology, APHP, Saint-Antoine Hospital, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Cosnes
authors.affiliation: Department of Gastroenterology, APHP, Saint-Antoine Hospital, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Beaugerie
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Clostridium difficile infection; Inflammatory bowel disease; Nonsteroidal anti-inflammatory drugs