C difficile Disease in Hospitalized Patients With IBD
C difficile Disease in Hospitalized Patients With IBD
What do the latest data say about the clinical impact of Clostridium difficile-associated disease in hospitalized patients with inflammatory bowel disease (IBD)?
Clostridium difficile infection should always be included in the differential diagnosis for a patient with refractory inflammatory bowel disease (IBD) symptoms. There is currently an alarming increase in the incidence of C difficile infection in the United States, and there are epidemiologic data to suggest that more virulent strains are emerging. Assessing for infection should include testing for C difficile toxins A and B. Patients with IBD do not necessarily require a history of antibiotic use or hospitalization to acquire the infection, 2 facts that are also worrisome. A patient who contracts community-acquired C difficile infection does not have a better course than one who becomes infected while hospitalized.
Recent data demonstrate longer hospital stays, with increased costs and more complications including colectomy and the need for more aggressive immunosuppression to treat the underlying IBD in the hospitalized patient with both IBD and C difficile infection. When a patient is hospitalized for refractory symptoms, the management algorithm should include serial stool specimens for C difficile toxin. If results are negative, the tests should be repeated during the hospitalization if the patient fails to respond as expected to standard treatment.
Question
What do the latest data say about the clinical impact of Clostridium difficile-associated disease in hospitalized patients with inflammatory bowel disease (IBD)?
Response from Sunanda V. Kane, MD, MSPH, FACG
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Sunanda V. Kane, MD, MSPH, FACG Associate Professor of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota; Senior Associate Consultant of Medicine, Mayo Clinic, Rochester, Minnesota |
Clostridium difficile infection should always be included in the differential diagnosis for a patient with refractory inflammatory bowel disease (IBD) symptoms. There is currently an alarming increase in the incidence of C difficile infection in the United States, and there are epidemiologic data to suggest that more virulent strains are emerging. Assessing for infection should include testing for C difficile toxins A and B. Patients with IBD do not necessarily require a history of antibiotic use or hospitalization to acquire the infection, 2 facts that are also worrisome. A patient who contracts community-acquired C difficile infection does not have a better course than one who becomes infected while hospitalized.
Recent data demonstrate longer hospital stays, with increased costs and more complications including colectomy and the need for more aggressive immunosuppression to treat the underlying IBD in the hospitalized patient with both IBD and C difficile infection. When a patient is hospitalized for refractory symptoms, the management algorithm should include serial stool specimens for C difficile toxin. If results are negative, the tests should be repeated during the hospitalization if the patient fails to respond as expected to standard treatment.