title: Recurrence of Clostridium difficile Infection in Patients with Inflammatory Bowel Disease: The RECIDIVISM Study.
abstract: Recurrent Clostridium difficile infection (rCDI) contributes to a significant burden of disease in patients with inflammatory bowel disease (IBD). In this study, we seek to identify risk factors for rCDI in a population of IBD patients at the Mount Sinai Hospital IBD Centre.
  
  
  
  In this retrospective cohort study, IBD patients with rCDI diagnosed between 2010 and 2013 were identified and compared with IBD patients with single-episode CDI. Multivariate regression was used to identify predictors of rCDI in IBD. Outcome analysis was performed for hospitalizations due to CDI, colectomy, and CDI-attributable mortality.
  
  
  
  A total of 503 patients were included, 110 (22%) of whom had IBD (49% CD, 51% ulcerative colitis). Recurrent CDI occurred in 32% of IBD patients compared with 24% of non-IBD patients (P<0.01). IBD patients with rCDI were more likely than those without rCDI to report recent antibiotic therapy (42.9 vs. 30.7%, P<0.01), 5-aminosalicylic acid (5-ASA) use (51.5 vs. 30.7%, P<0.001), steroid use (51.4 vs. 33.3%, P<0.001), and biologic therapy (48.6 vs. 40.0%, P<0.01). Infliximab (34.3 vs. 17.3%, P<0.01) but not adalimumab was associated with more rCDI events. Using a Cox model of predictors of rCDI in IBD, significant predictors included non-ileal Crohn's disease (hazard ratio (HR) 2.85, 95% confidence interval (CI) 1.30-6.30) and the use of 5-ASA (HR 2.15, 95% CI 1.11-4.18).
  
  
  
  Compared with the general population, IBD patients are 33% more likely to experience rCDI. Within the IBD cohort, exposure to certain drug classes (antibiotics, 5-ASA, steroids, certain biologics) and non-ileal Crohn's disease were found to be the predictors of rCDI.
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada.|Division of Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Roshan
authors.initials: R
authors.lastname: Razik
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Amir
authors.initials: A
authors.lastname: Rumman
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Zoya
authors.initials: Z
authors.lastname: Bahreini
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Allison
authors.initials: A
authors.lastname: McGeer
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Nguyen
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology / Q000401:mortality; D003082:Colectomy / Q000706:statistics & numerical data; D003093:Colitis, Ulcerative / Q000453:epidemiology*; D003424:Crohn Disease / Q000453:epidemiology*; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D005938:Glucocorticoids; D019804:Mesalamine; D000069285:Infliximab; D000068879:Adalimumab