Study Data Suggest That Cancer, Irritable Bowel Disease Are Associated With Risk of C Diff Infection

Patients who are immunocompromised may have a higher risk of contracting clostridium difficile (C. diff) infection (CDI) compared to patients who are not immunocompromised, according to the results of a retrospective study out of Jeddah, Saudi Arabia, and published in Interdisciplinary Perspectives on Infectious Diseases. In addition, those with irritable bowel disease (IBD) leading to gut dysbiosis were found to have higher rates of CDI and recurrence.

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C. diff is a Gram-positive spore-forming anaerobic bacillus that is commonly found in the gut. This contagious infection, contracted via a fecal-oral pathway, is one of the primary causes of nosocomial infection in developed countries. Often associated with diarrhea, this severe and possibly fatal infection is increasing globally.

Investigators conducted a retrospective study to evaluate CDI prevalence in adult and pediatric patients, collecting data on 89 patients from King Abdulaziz Medical City (KAMC) who had a recorded case of CDI between 2016 and 2020.

Most patients with CDI were found to be immunocompromised (87.6%), and the rate of recurrence was higher among the immunocompromised group (38.4%) compared with patients who were not immunocompromised (27.2%). In the group with immunosuppression, investigators also observed that cancer was the foremost cause of CDI.

IBD, which consists of Crohn disease and ulcerative colitis, has also been associated with the rate of CDI in adult and pediatric populations. Findings from previous studies suggest that adults hospitalized with IBD, with symptoms including abdominal pain, rectal bleeding, persistent diarrhea, weight loss, fatigue, or damage to the gastrointestinal tract (Crohn disease), may have a 12-times higher risk of contracting CDI, and generally any patient with IBD may be at risk of severe CDI compared to patients without IBD.

Due to the risk of CDI being higher for patients with IBD compared to those without gut dysbiosis, investigators also compared CDI prevalence between patients with and without IBD.According to results, IBD is associated with increased risk of contracting CDI and higher rates of CDI recurrence or colectomy compared to their non-IBD counterparts.

There is also an increasing rate of pediatric IBD worldwide, which means that CDI burden is also starting to become more similar across age groups. However, CDI incidence was still higher among adults.

Further, almost 70% of patients with CDI had been treated with antibiotics at some point, making it a risk factor for CDI. But despite the risk that antibiotics have on gut diversity and dysbiosis, a standard of care for treating CDI is antibiotics (vancomycin and metronidazole).

“We found the recurrence of CDI in 37.1% of the patients who were treated with the first line of treatment [of antibiotics],” wrote study authors in the article.

Ultimately, investigators recognize that there are many other risk factors to CDI, including older age (age 65 years or older), higher occurrence of comorbidities, hospitalization, and treatment with broad-spectrum antibiotics, proton pump inhibitors, and histamine H2-receptor antagonists. Moreover, hospitalization was associated with disease severity in this study, but community-acquired CDI was not.

There were 2 main limitations in the study. First, the study population was part of a single-center cohort, which may limit the generalizability of findings. Second, it is not possible to find differences in incidence and disease prevalence by region.

Reference

Sukkar GA, Aga SS, Alsamadani AH, et al. Prevalence of Clostridium Difficile Infection (CDI) among Inflammatory Bowel Disease (IBD) Patients in Comparison to Non-IBD Patients in King Abdulaziz Medical City in Jeddah. Interdiscip Perspect Infect Dis. 2023: 9958104. doi:10.1155/2023/9958104