title: Incidence and risk factors of Clostridium difficile infection in patients with inflammatory bowel disease.
abstract: Recent changes in the epidemiology of Clostridium difficile infection (CDI) include the identification of patients with inflammatory bowel disease (IBD) as a group at risk in comparison to the general population.
  
  
  OBJECTIVE
  To identify the incidence and risk factors for CDI among patients with IBD.
  
  
  METHODS
  Case-control study of 78 patients diagnosed with IBD, hospitalized at the Iasi Institute of Gastroenterology and Hepatology between January 2012 and -July 2014. Demographic data and clinical characteristics were reviewed for all patients. IBD patients with positive C. difficile toxins A and B tests were matched by sex, age and type of IBD with IBD patients hospitalized in the same period with negative C. difficile toxins tests.
  
  
  RESULTS
  Both groups were comparable for baseline characteristics. Of the 78 patients diagnosed with IBD included in the study, C. difficile was detected in 26 patients (33.33%). There was no statistical difference regarding length of hospital stay (10.42 ± 7.34 vs. 8.01 ± 16.14 days, p = 0.129) between the two study groups. Risk factors for CDI in patients with IBD were: ulcerative colitis (OR = 1.90, CI = 1.320-2.720, p = 0.001), use of proton pump inhibitors (OR = 1.57, CI = 1.133-2.032, p = 0.012), previous antibiotic use (OR = 2.3, CI = 1.587-3.332, p < 0.0001), and albumin < 3 g/dl (OR = 1.78, CI = 1.023-5.558, p = 0.038). Immunosuppressive and anti TNF-α treatment were not risk factors for C. difficile development in patients with IBD.
  
  
  CONCLUSIONS
  CDI in patients with IBD is a serious infection and should be treated aggressively with close clinical follow-up. Ulcerative colitis, previous treatment with antibiotics and proton pump inhibitors represent risk factors for CDI development in patients with IBD.
authors.forename: Oana
authors.initials: O
authors.lastname: Stoica
authors.forename: Anca
authors.initials: A
authors.lastname: Trifan
authors.forename: Camelia
authors.initials: C
authors.lastname: Cojocariu
authors.forename: Irina
authors.initials: I
authors.lastname: Gîrleanu
authors.forename: Roxana
authors.initials: R
authors.lastname: Maxim
authors.forename: Maxim C
authors.initials: MC
authors.lastname: Stanciu
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification; D003015:Clostridium Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D003093:Colitis, Ulcerative / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012383:Romania / Q000453:epidemiology