SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Philippe SEKSIK
Coup de coeur :
 
 
Gastroenterology
  2017/08  
 
  2017 Aug;153(2):430-438.e2.  
  doi: 10.1053/j.gastro.2017.04.044  
 
  Higher Incidence of Clostridium difficile Infection Among Individuals With Inflammatory Bowel Disease  
 
  Singh H, Nugent Z, Yu BN, Lix LM, Targownik LE, Bernstein CN  
  https://www.ncbi.nlm.nih.gov/pubmed/28479377  
 
 

Abstract

BACKGROUND & AIMS:

Studies of Clostridium difficile infections (CDIs) among individuals with inflammatory bowel disease (IBD) have used data from single centers or CDI administrative data codes of limited diagnostic accuracy. We determined the incidence, risk factors, and outcomes after CDI in a population-based cohort of patients with IBD and laboratory confirmation diagnoses of CDI.

METHODS:

We searched the University of Manitoba IBD Epidemiology Database and Manitoba Health CDI databases to identify individuals with CDI, with or without IBD, from July 1, 2005 through March 31, 2014. Time trends of incidence were assessed using joinpoint regression. Multivariable Cox regression analyses were performed to assess differences in CDI incidence rates and mortality after CDI between individuals with and without IBD. Conditional logistic regression was performed to determine predictors of CDI among individuals with IBD.

RESULTS:

Individuals with IBD had a 4.8-fold increase in risk of CDI than individuals without IBD; we found no difference between individuals with ulcerative colitis vs Crohn's disease. There was no increase in CDI incidence over the study time period in either group. Among individuals with IBD, exposure to corticosteroids, infliximab or adalimumab, metronidazole, hospitalizations, higher ambulatory care visits, shorter duration of IBD, and higher comorbidities were associated with an increased risk of CDI. Although CDI increased mortality among individuals with and without IBD, there was lower mortality after CDI among individuals with IBD than without IBD (hazard ratio, 0.65; 95% confidence interval, 0.44-0.96).

CONCLUSIONS:

CDI incidence is no longer increasing among individuals with IBD. We identified unique risk factors for CDI in patients with IBD. CDI is associated with a greater increase in mortality among individuals without IBD than with IBD.

 
Question posée
 
Chez les aptients ayant une MICI, les infections à C. difficile sont-elles plus fréquentes ?
 
Question posée
 
Oui.
 
Commentaires

Etude multicentrique qui montre que la RCH et la Maladie de Crohn exposent à un sur-risque d’infection à C. difficile (presque 5 fois plus qu’en l’absence de MICI). Notion à garder en tête pour dépister C. difficile et le traiter au cours des 2 maladies inflammatoires.

 
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