Combination Immunomodulator and Antibiotic Treatment in Patients With Inflammatory Bowel Disease and Clostridium difficile Infection

被引:131
作者
Ben-Horin, Shomron [1 ]
Margalit, Maya [2 ]
Bossuyt, Peter [3 ]
Maul, Jochen [4 ]
Shapira, Yami [5 ]
Bojic, Daniela [6 ]
Chermesh, Irit [7 ]
Al-Rifai, Ahmad [8 ]
Schoepfer, Alain [9 ]
Bosani, Matteo [10 ]
Allez, Matthieu [11 ]
Lakatos, Peter Laszlo [12 ]
Bossa, Fabrizio [13 ]
Eser, Alexander [14 ]
Stefanelli, Tommaso [15 ]
Carbonnel, Franck [16 ]
Katsanos, Konstantinos [17 ]
Checchin, Davide [18 ]
Saenz De Miera, Ines [19 ]
Chowers, Yehuda [7 ]
Moran, Gordon William [20 ]
机构
[1] Tel Aviv Univ, Dept Gastroenterol, Sheba Med Ctr, IL-52621 Tel Hashomer, Israel
[2] Hebrew Univ Jerusalem, Hadassah Med Ctr, Jerusalem, Israel
[3] Univ Leuven Hosp, Louvain, Belgium
[4] Charite, Med Klin 1, D-13353 Berlin, Germany
[5] Tel Aviv Med Ctr & Sch Med, Tel Aviv, Israel
[6] Zvezdara Univ, Ctr Med, Belgrade, Serbia
[7] Technion Israel Inst Technol, Rambam Med Ctr, Haifa, Israel
[8] Salford NHS Univ Hosp, Manchester, Lancs, England
[9] Univ Hosp Bern, Bern, Switzerland
[10] Sacco Univ Hosp, Milan, Italy
[11] St Louis Hosp, Paris, France
[12] Semmelweis Univ, H-1085 Budapest, Hungary
[13] Casa Sollievo Sofferenza Hosp, San Giovanni Rotondo, Italy
[14] Med Univ Vienna, Vienna, Austria
[15] Univ Studi Milano, Milan, Italy
[16] Univ Hosp Besancon, Besancon, France
[17] Univ Hosp Ioannina, Ioannina, Greece
[18] Univ Padua, I-35100 Padua, Italy
[19] Hosp Gen Yague, Burgos, Spain
[20] Univ Birmingham, Birmingham B15 2TT, W Midlands, England
关键词
RISK-FACTORS; COLITIS; DIARRHEA; IMPACT; TOXIN; OUTCOMES; STOOL;
D O I
10.1016/j.cgh.2009.05.031
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
BACKGROUND & AIMS: Management of Clostridium difficile infection in patients with flaring inflammatory bowel disease (IBD) has not been optimized. We investigated the effects of combination therapy with antibiotics and immunomodulators in patients with IBD and C difficile infection. METHODS: We analyzed data from 155 patients (59% with ulcerative colitis [UC]) from a retrospective, European Crohn's and Colitis organization, multi-center study comparing outcome of hospitalized IBD patients with C difficile infection who were treated with antibiotics (n = 51) or antibiotics and immunomodulators (n = 104). The primary composite Outcome was death or colectomy within 3 months of admission, in-hospital megacolon, bowel perforation, hemodynamic shock, or respiratory failure. RESULTS: The primary outcome occurred in 12% of patients given the combination treatment vs none of the patients given antibiotics alone (P = .01). UC, abdominal tenderness, or severe bloody diarrhea was more common among patients that received the combined therapy. However, multivariate analysis revealed that only the combination therapy maintained a trend for an independent association with the primary outcome (likelihood ratio = 11.9; CI, 0.9-157; P = .06). Treatment with 2 or 3 immunomodulators was correlated with the primary outcome, independent of disease severity at presentation (odds ratio [OR] = 17; CI, 3.2-91; P < .01). Acid-suppressing medications increased the risk of C difficile relapse (OR = 3.8; CI, 1.1-12.9; P = .03), whereas recent hospitalization correlated with increased rate of C difficile persistence (OR = 8; CI, 2.1-2.9; P = .002). CONCLUSIONS: Patients with IBD that also have C difficile infection are frequently treated with a combination of antibiotics and immunomodulators. However, this combination tends to associate with a worse outcome than antibiotic therapy alone. Prospective controlled trials are urgently needed to optimize the management of these challenging patients.
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收藏
页码:981 / 987
页数:7
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