[Biological therapy in women with inflammatory bowel disease during pregnancy]. / Biologická terapie u pacientek s idiopatickými strevními zánety v gravidite

The aim of this article is to objective review available research data regarding the safety of biological therapies during pregnancy and breastfeeding in women with inflammatory bowel disease. Biological therapies appear to be safe in pregnancy, as no increased risk of malformations has been demonstrated. Available clinical results suggest that the efficacy of infliximab and adalimumab in achieving clinical response and maintaining remission in pregnant patients might outweigh the theoretical risks of drug exposure to the fetus. If possible, anti-TNF therapy should be stopped by the end of the second trimester due to transplacental transfer and potential risk for the fetus. The use of infliximab and adalimumab is probably compatible with breastfeeding.

Clostridium difficile infection in hospitalized patients at a Czech tertiary center: analysis of epidemiology, clinical features, and risk factors of fulminant course.

OBJECTIVE: Clostridium difficile infection (CDI) has been increasing in incidence, with significant morbidity and mortality, and is subject to geographical and institutional variability. We aimed to characterize epidemiology and clinical manifestations of CDI in a Czech tertiary care center and to identify risk factors of fulminant course. METHODS: All adult patients hospitalized with primary CDI in a 3-year period were retrospectively identified. Epidemiological and clinically descriptive data were extracted from medical records. Multivariate analysis was used to identify the risk factors of fulminant course. The relationship between incidence of CDI and antibiotic consumption was evaluated. RESULTS: Overall, 183 CDI patients, median age 67 years, were enrolled. Hospital-acquired CDI was present in 85% of cases. The incidence of CDI was 1/10,000 patient-days. Hospital-acquired CDI hospital mortality was 22.4%. Severe CDI (SCDI) was identified in 15.8% of patients, with 62% mortality. SCDI patients had longer onset of symptoms to diagnosis interval compared with mild CDI (P=0.05). Multivariate analysis showed that SCDI patients were older (P=0.018), and more frequently had abnormal abdominal physical findings (P=0.001), higher inflammatory markers (P<0.001), higher creatinine (P=0.002), and lower albumin (P<0.001) than patients with mild CDI. Analysis of antibiotic consumption at departments with the highest incidence of CDI showed a trend toward higher incidence of CDI associated with penicillin use (P=0.08) and a negative correlation of CDI incidence with nitroimidazoles consumption (P=0.03). CONCLUSION: CDI is less frequent in the conditions studied compared with literary data; however, the fulminant form has a very high mortality. Delayed recognition and treatment is a crucial determinant of the severity of CDI. The association between CDI and antibiotic consumption is less clear.