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The impact of corticosteroid use on inpatients with inflammatory bowel disease and positive polymerase chain reaction for Clostridium difficile
Intestinal Research ; : 244-252, 2019.
Article in English | WPRIM | ID: wpr-764134
ABSTRACT
BACKGROUND/

AIMS:

Optimal management of inflammatory bowel disease (IBD) with concomitant Clostridium difficile infection (CDI) is controversial, especially when CDI diagnosis is made by polymerase chain reaction (PCR) testing, which may reflect colonization without infection.

METHODS:

We performed a multicenter review of all inpatients with IBD and PCR diagnosed CDI. Outcomes included length of stay, 30- and 90-day readmission, colectomy during admission and within 3 months, intensive care unit (ICU) admission, CDI relapse and death for patients who received corticosteroid (CS) after CDI diagnosis versus those that did not. Propensity-adjusted regression analysis of outcomes based on CS usage was performed.

RESULTS:

We identified 177 IBD patients with CDI, 112 ulcerative colitis and 65 Crohn's disease. For IBD overall, CS after CDI diagnosis was associated with prolonged hospitalization (5.5 days 95% confidence interval [CI], 1.5–9.6 days; P=0.008), higher colectomy rate within 3 months (odds ratio [OR], 5.5; 95% CI, 1.1–28.2; P=0.042) and more frequent ICU admissions (OR, 7.8; 95% CI, 1.5–41.6; P=0.017) versus no CS. CS use post-CDI diagnosis in UC patients was associated with prolonged hospitalization (6.2 days 95% CI, 0.4– 12.0 days; P=0.036) and more frequent ICU admissions (OR, 7.4; 95% CI, 1.1–48.7; P=0.036).

CONCLUSIONS:

CS use among IBD inpatients with CDI diagnosed by PCR is associated with poorer outcomes and would seem to reinforce the importance of C. difficile toxin assay to help distinguish colonization from infection. This adverse effect appears more prominent among those with UC.
Subject(s)

Full text: Available Index: WPRIM (Western Pacific) Main subject: Recurrence / Inflammatory Bowel Diseases / Colitis, Ulcerative / Crohn Disease / Polymerase Chain Reaction / Clostridioides difficile / Clostridium / Adrenal Cortex Hormones / Colectomy / Colon Type of study: Controlled clinical trial / Diagnostic study Limits: Humans Language: English Journal: Intestinal Research Year: 2019 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Recurrence / Inflammatory Bowel Diseases / Colitis, Ulcerative / Crohn Disease / Polymerase Chain Reaction / Clostridioides difficile / Clostridium / Adrenal Cortex Hormones / Colectomy / Colon Type of study: Controlled clinical trial / Diagnostic study Limits: Humans Language: English Journal: Intestinal Research Year: 2019 Type: Article