Risk Factors Associated with Clostridium difficile infection in inflammatory bowel disease: A systematic review and meta-analysis

Bhairavi Balram, Robert Battat, Alex Al-Khoury, Julie D’Aoust, Waqqas Afif, Alain Bitton, P. Lakatos, Talat Bessissow

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background and Aim: Clostridium difficile infection [CDI] is a significant concern in inflammatory bowel disease [IBD]. Risk factors and consequences associated with CDI in inflammatory bowel disease [IBD] patients are important to characterize. The aim of this research was to perform a systematic review and meta-analysis on risk factors and outcomes associated with CDI in IBD patients. Methods: Multiple databases were searched for studies investigating risk factors, colectomy and mortality risk in IBD patients with and without CDI. This was stratified by short [<3 months] and long-term [>1 year] outcomes. Summary estimates were calculated using a random-effects model. Quality assessment used the Newcastle–Ottawa scale. Results: Twenty-two studies met inclusion criteria. Antibiotics use within 30 days of diagnosis was associated with CDIs (odds ratio [OR]: 1.85, 95% confidence interval [CI]:1.36, 2.52). Colonic involvement in Crohn’s disease patients was associated with significantly higher CDI rates [OR: 2.76, 95% CI: 1.75, 4.35]. There was a significant association between biologic medication use and CDI [OR: 1.65, 95% CI: 1.18, 2.30], with minimal heterogeneity [I2 = 4.0%]. The long-term colectomy risk was significantly higher for IBD patients with CDI compared with that for IBD patients without CDI [OR: 2.22, 95% CI: 1.17, 4.18]. Significantly higher mortality was found for CDI in IBD patients both short-term [OR: 3.84, 95% CI: 2.62, 5.61] and long-term [OR: 3.65, 95% CI: 1.58, 8.44]. Substantial heterogeneity existed. Most studies were of moderate quality. Conclusion: Colonic involvement, and biologic and antibiotic use appear to be risk factors associated with CDI among IBD patients. CDI is associated with increased short- and long-term mortality.

Original languageEnglish
Pages (from-to)27-38
Number of pages12
JournalJournal of Crohn's and Colitis
Volume13
Issue number1
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Clostridium Infections
Clostridium difficile
Inflammatory Bowel Diseases
Meta-Analysis
Odds Ratio
Confidence Intervals
Colectomy
Mortality
Anti-Bacterial Agents
Crohn Disease

Keywords

  • Clostridium difficile infection
  • Colectomy
  • Inflammatory bowel disease
  • Meta-analysis
  • Mortality
  • Risk factors

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Risk Factors Associated with Clostridium difficile infection in inflammatory bowel disease : A systematic review and meta-analysis. / Balram, Bhairavi; Battat, Robert; Al-Khoury, Alex; D’Aoust, Julie; Afif, Waqqas; Bitton, Alain; Lakatos, P.; Bessissow, Talat.

In: Journal of Crohn's and Colitis, Vol. 13, No. 1, 01.01.2019, p. 27-38.

Research output: Contribution to journalArticle

Balram, Bhairavi ; Battat, Robert ; Al-Khoury, Alex ; D’Aoust, Julie ; Afif, Waqqas ; Bitton, Alain ; Lakatos, P. ; Bessissow, Talat. / Risk Factors Associated with Clostridium difficile infection in inflammatory bowel disease : A systematic review and meta-analysis. In: Journal of Crohn's and Colitis. 2019 ; Vol. 13, No. 1. pp. 27-38.
@article{84370306266e4be181b1050264a4b4f6,
title = "Risk Factors Associated with Clostridium difficile infection in inflammatory bowel disease: A systematic review and meta-analysis",
abstract = "Background and Aim: Clostridium difficile infection [CDI] is a significant concern in inflammatory bowel disease [IBD]. Risk factors and consequences associated with CDI in inflammatory bowel disease [IBD] patients are important to characterize. The aim of this research was to perform a systematic review and meta-analysis on risk factors and outcomes associated with CDI in IBD patients. Methods: Multiple databases were searched for studies investigating risk factors, colectomy and mortality risk in IBD patients with and without CDI. This was stratified by short [<3 months] and long-term [>1 year] outcomes. Summary estimates were calculated using a random-effects model. Quality assessment used the Newcastle–Ottawa scale. Results: Twenty-two studies met inclusion criteria. Antibiotics use within 30 days of diagnosis was associated with CDIs (odds ratio [OR]: 1.85, 95{\%} confidence interval [CI]:1.36, 2.52). Colonic involvement in Crohn’s disease patients was associated with significantly higher CDI rates [OR: 2.76, 95{\%} CI: 1.75, 4.35]. There was a significant association between biologic medication use and CDI [OR: 1.65, 95{\%} CI: 1.18, 2.30], with minimal heterogeneity [I2 = 4.0{\%}]. The long-term colectomy risk was significantly higher for IBD patients with CDI compared with that for IBD patients without CDI [OR: 2.22, 95{\%} CI: 1.17, 4.18]. Significantly higher mortality was found for CDI in IBD patients both short-term [OR: 3.84, 95{\%} CI: 2.62, 5.61] and long-term [OR: 3.65, 95{\%} CI: 1.58, 8.44]. Substantial heterogeneity existed. Most studies were of moderate quality. Conclusion: Colonic involvement, and biologic and antibiotic use appear to be risk factors associated with CDI among IBD patients. CDI is associated with increased short- and long-term mortality.",
keywords = "Clostridium difficile infection, Colectomy, Inflammatory bowel disease, Meta-analysis, Mortality, Risk factors",
author = "Bhairavi Balram and Robert Battat and Alex Al-Khoury and Julie D’Aoust and Waqqas Afif and Alain Bitton and P. Lakatos and Talat Bessissow",
year = "2019",
month = "1",
day = "1",
doi = "10.1093/ecco-jcc/jjy143",
language = "English",
volume = "13",
pages = "27--38",
journal = "Journal of Crohn's and Colitis",
issn = "1873-9946",
publisher = "Elsevier",
number = "1",

}

TY - JOUR

T1 - Risk Factors Associated with Clostridium difficile infection in inflammatory bowel disease

T2 - A systematic review and meta-analysis

AU - Balram, Bhairavi

AU - Battat, Robert

AU - Al-Khoury, Alex

AU - D’Aoust, Julie

AU - Afif, Waqqas

AU - Bitton, Alain

AU - Lakatos, P.

AU - Bessissow, Talat

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background and Aim: Clostridium difficile infection [CDI] is a significant concern in inflammatory bowel disease [IBD]. Risk factors and consequences associated with CDI in inflammatory bowel disease [IBD] patients are important to characterize. The aim of this research was to perform a systematic review and meta-analysis on risk factors and outcomes associated with CDI in IBD patients. Methods: Multiple databases were searched for studies investigating risk factors, colectomy and mortality risk in IBD patients with and without CDI. This was stratified by short [<3 months] and long-term [>1 year] outcomes. Summary estimates were calculated using a random-effects model. Quality assessment used the Newcastle–Ottawa scale. Results: Twenty-two studies met inclusion criteria. Antibiotics use within 30 days of diagnosis was associated with CDIs (odds ratio [OR]: 1.85, 95% confidence interval [CI]:1.36, 2.52). Colonic involvement in Crohn’s disease patients was associated with significantly higher CDI rates [OR: 2.76, 95% CI: 1.75, 4.35]. There was a significant association between biologic medication use and CDI [OR: 1.65, 95% CI: 1.18, 2.30], with minimal heterogeneity [I2 = 4.0%]. The long-term colectomy risk was significantly higher for IBD patients with CDI compared with that for IBD patients without CDI [OR: 2.22, 95% CI: 1.17, 4.18]. Significantly higher mortality was found for CDI in IBD patients both short-term [OR: 3.84, 95% CI: 2.62, 5.61] and long-term [OR: 3.65, 95% CI: 1.58, 8.44]. Substantial heterogeneity existed. Most studies were of moderate quality. Conclusion: Colonic involvement, and biologic and antibiotic use appear to be risk factors associated with CDI among IBD patients. CDI is associated with increased short- and long-term mortality.

AB - Background and Aim: Clostridium difficile infection [CDI] is a significant concern in inflammatory bowel disease [IBD]. Risk factors and consequences associated with CDI in inflammatory bowel disease [IBD] patients are important to characterize. The aim of this research was to perform a systematic review and meta-analysis on risk factors and outcomes associated with CDI in IBD patients. Methods: Multiple databases were searched for studies investigating risk factors, colectomy and mortality risk in IBD patients with and without CDI. This was stratified by short [<3 months] and long-term [>1 year] outcomes. Summary estimates were calculated using a random-effects model. Quality assessment used the Newcastle–Ottawa scale. Results: Twenty-two studies met inclusion criteria. Antibiotics use within 30 days of diagnosis was associated with CDIs (odds ratio [OR]: 1.85, 95% confidence interval [CI]:1.36, 2.52). Colonic involvement in Crohn’s disease patients was associated with significantly higher CDI rates [OR: 2.76, 95% CI: 1.75, 4.35]. There was a significant association between biologic medication use and CDI [OR: 1.65, 95% CI: 1.18, 2.30], with minimal heterogeneity [I2 = 4.0%]. The long-term colectomy risk was significantly higher for IBD patients with CDI compared with that for IBD patients without CDI [OR: 2.22, 95% CI: 1.17, 4.18]. Significantly higher mortality was found for CDI in IBD patients both short-term [OR: 3.84, 95% CI: 2.62, 5.61] and long-term [OR: 3.65, 95% CI: 1.58, 8.44]. Substantial heterogeneity existed. Most studies were of moderate quality. Conclusion: Colonic involvement, and biologic and antibiotic use appear to be risk factors associated with CDI among IBD patients. CDI is associated with increased short- and long-term mortality.

KW - Clostridium difficile infection

KW - Colectomy

KW - Inflammatory bowel disease

KW - Meta-analysis

KW - Mortality

KW - Risk factors

UR - http://www.scopus.com/inward/record.url?scp=85058918356&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058918356&partnerID=8YFLogxK

U2 - 10.1093/ecco-jcc/jjy143

DO - 10.1093/ecco-jcc/jjy143

M3 - Article

C2 - 30247650

AN - SCOPUS:85058918356

VL - 13

SP - 27

EP - 38

JO - Journal of Crohn's and Colitis

JF - Journal of Crohn's and Colitis

SN - 1873-9946

IS - 1

ER -