title: Risk factors and clinical outcome of Clostridium difficile infection in patients with IBD: A single-center retrospective study of 260 cases in China.
abstract: OBJECTIVE
  Clostridium difficile infection (CDI) may lead to poor outcomes in patients with inflammatory bowel disease (IBD). In this study we aimed to investigate the cumulative incidence, risk factors and outcome of CDI in patients with IBD in a single center in China.
  
  
  METHODS
  The clinical features and endoscopic profiles of consecutive IBD patients admitted to Ruijin Hospital, Shanghai Jiaotong University School of Medicine between January 2013 and December 2015 were retrospectively analyzed. CDI was diagnosed based on a positive polymerase chain reaction (PCR) stool test.
  
  
  RESULTS
  A total of 260 patients with IBD were enrolled, including 176 with Crohn's disease (CD) and 84 with ulcerative colitis (UC). Altogether 13 (5.0%) patients were diagnosed with CDI. The incidence of CDI was 4.0% (7/176) in CD and 7.1% (6/84) in UC, respectively. The endoscopic feature of pseudomembrane was found in four (33.3%) IBD-CDI patients, and pseudomembrane and deep ulcers were significantly correlated with CDI (P < 0.001 and P = 0.006, respectively). Hemoglobin (Hb) <100 g/L was found to be associated with CDI (OR 3.48, 95% CI 1.04-11.61, P = 0.043). Patients in the CDI group showed a higher risk of developing abdominal abscesses than those in the non-CDI group (OR 6.09, 95% CI 1.8-15.2, P = 0.003).
  
  
  CONCLUSIONS
  PCR-based fecal test for CDI should be performed in these IBD patients. Hb <100 g/L may be an important risk factor for CDI in IBD. For patients with CDI, antibiotics should be administered promptly to prevent abdominal abscess.
authors.affiliation: Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Yu Bei
authors.identifier: http://orcid.org/0000-0002-4940-5303
authors.initials: YB
authors.lastname: Gu
authors.affiliation: Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Mao Chen
authors.initials: MC
authors.lastname: Zhang
authors.affiliation: Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Sun
authors.affiliation: Department of Colorectal Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Ke Zhi
authors.initials: KZ
authors.lastname: Lv
authors.affiliation: Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhong
mesh_terms: D018784:Abdominal Abscess / Q000382:microbiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D003015:Clostridium Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D003113:Colonoscopy; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: 
  Clostridium difficile
  ; inflammatory bowel disease; risk factors; treatment outcome