Epidemiology, Diagnosis, and Management of Clostridium difficile Infection in Patients with Inflammatory Bowel Disease.
Clostridium difficile infection (CDI) is a major source of morbidity and mortality for the U.S. health care system and frequently complicates the course of inflammatory bowel disease (IBD). Patients with IBD are more likely to be colonized with C. difficile and develop active infection than the general population. They are also more likely to have severe CDI and develop subsequent complications such as IBD flare, colectomy, or death. Even after successful initial treatment and recovery, recurrent CDI is common. Management of CDI in IBD is fraught with diagnostic and therapeutic challenges because the clinical presentations of CDI and IBD flare have considerable overlap. Fecal microbiota transplantation can be successful in curing recurrent CDI when other treatments have failed, but may also trigger IBD flare and this warrants caution. New experimental treatments including vaccines, monoclonal antibodies, and nontoxigenic strains of C. difficile offer promise but are not yet available for clinicians. A better understanding of the complex relationship between the gut microbiota, CDI, and IBD is needed.
*Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; †Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan; ‡Division of Infectious Diseases, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan; and §Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan.
Krishna
K
Rao
Peter D R
PD
Higgins
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile; D004761:Enterocolitis, Pseudomembranous / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D000069467:Fecal Microbiota Transplantation / Q000009:adverse effects; D006801:Humans; D007167:Immunotherapy; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D019936:Probiotics / Q000627:therapeutic use; D012008:Recurrence; D012720:Severity of Illness Index; D000067251:Symptom Flare Up
D000900:Anti-Bacterial Agents