A useful review of Clostridium difficile infection (CDI) in the inflammatory bowel disease population has been published and makes several useful points (Inflamm Bowel Dis 2013; 19: 194-204). (Thanks to Ben Gold for suggesting this reference.)
- The incidence of CDI in IBD patients is increasing (faster than general population). The prevalence of CDI in IBD was nearly eight times greater than non-iBD gastrointestinal patients in a recent population-based study (37.3 cases vs. 4.8 cases per 1000 discharges).
- Though there is some conflicting data, CDI appears to worsen both short- and long-term outcomes in IBD patients.
- Carriage (asymptomatic) rates in outpatient IBD patients is higher than the general population (8.2% vs. 1%) according to a recent study.
- Endoscopic appearance of CDI is rarely classic in the setting of IBD. Only 13% of hospitalized IBD patients with CDI had pseudomembranes (J Crohns Colitis 2010; 4: 194-98). Thus, endoscopy has little utility in helping to distinguish IBD flare from superimposed infection.
- Unique IBD risk factors for CDI: colonic disease and steroid use.
- The review has a thorough discussion of the available testing and recommends testing only patients with unformed stools unless an ileus is present.
- For recurrent disease, the authors suggest prolonged tapered vancomycin in adults: 125 mg QID for 10-14 days, then 125 mg BID x 1 week, then 125 mg QD x 1 week, then 125 mg QOD for 2-8 weeks. Alternative approaches could included fidaxomicin, IVIG/antibody therapy, and fecal transplantation.
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