Clostridium difficile in ulcerative colitis; a retrospective study

Aim: To study epidemiology and risk factors of Clostridium difficile infection (CDI) and its association with colectomy rates in patients with ulcerative colitis (UC). Materials and methods: We retrospectively analyzed medical files of 1179 patients with inflammatory bowel disease who had been treated from January 1 to December 31, 2017, in the Loginov Moscow Clinical Scientific Center (Moscow, Russia). UC was diagnosed according to the International Classification of Diseases, v. 10 (ICD10: K51). Final analysis included data from 400 UC patients. Depending on the presence of preliminary CDI diagnosis, the patients were divided into two groups: 79 (19.75%) patients with UC had at least one confirmed CDI episode, whereas 321 (80.25%) patients had no history of CDI. Results: CDI prevalence in UC patients was 19.75%, and 88.6% of the infectious episodes were community-acquired, whereas only 5.1% occurred in the inpatients. Mean (± SD) age at CDI occurrence in patients with inflammatory bowel disease was 37.8 ± 12.9 years. Only 13.4% of the patients with UC and associated CDI had the history of antibiotic therapy, and 40.5% had been previously treated with steroids. Prolonged immunosuppressive therapy in UC patients was associated with CDI: 41.8% of those with CDI had been treated with azathioprine/6-mercaptopurin for a long time, while among those without CDI this treatment had been administered only to 14.6% (p < 0.001). CDI prevalence in the UC patients who had been treated with mesenchymal stromal bone marrow cells was significantly lower than in those who had been treated with genetically engineered biological agents, both with and without immunosuppressants (p < 0.05). Surgery (colectomy) was necessary in 3 out of 4 patients with extremely severe UC associated with CDI, and in 2 out of 18 patients with extremely severe UC exacerbation without CDI. Conclusion: Young UC patients are more susceptible to CDI and often do not have any conventional CDI risk factors. In UC patients, other risk factors than in the general population, may have a significant impact on the CDI occurrence. UC patients with CDI more often have a history of salicylate failure, they more frequently require biological treatments, have lower mean albumin levels and higher activity of the inflammation. Extremely severe UC episode associated with CDI significantly increases the risk of colectomy