Analysis of risk factors of Clostridioides difficile infection in patients with inflammatory bowel disease

Introduction:
Clostridioides difficile infection (CDI) is one of the most important challenges in contemporary gastroenterology. However, data from CDI studies are sometimes contradictory.

Aim:
To analyse the risk factors for CDI in patients with inflammatory bowel disease (IBD).

Material and methods:
This is a retrospective analysis of the medical records of 204 patients (77 IBD with CDI, 50 with IBD without CDI, and a control group of 77) hospitalised in a referral centre in Warsaw. Data were entered and analysed by using univariate logistic regression models.

Results:
Patients with IBD and CDI had significantly longer hospitalisation time than patients with IBD without CDI. The population of patients with CDI and IBD was statistically significantly younger (p < 0.001). Patients with IBD and CDI had a lower body mass index (p < 0.001) and were more often treated with antibiotics (p < 0.001). Prior antibiotic use (< 1 month) was a risk factor for CDI (p = 0.003). Lower body mass index (p < 0.001) and lower levels of albumins (p = 0.036) were strong risk factors for CDI in the study group. Additional risk factors were young age (p < 0.001), length of hospitalisation (p = 0.001), treatment with glucocorticosteroids (p = 0.001), immunosuppressive treatment (p = 0.001), and gastritis and/or duodenitis (p = 0.002). The study did not confirm that proton pump inhibitors or biologic treatment affected the risk of CDI.

Conclusions:
The risk factors for CDI in patients with IBD include younger age, female gender, low body mass index and hypoalbuminaemia, use of thiopurines, antibiotics, and glucocorticosteroids, prolonged hospitalisation, and gastritis and/or duodenitis.