Clostridium difficile, also known as C. difficile or C. diff, is a bacterium that can infect the bowel and cause diarrhoea. The infection most commonly affects people who have recently been treated with antibiotics, hospitalised patients, oncology patients, and immunocompromised individuals, as well as the elderly. Patients with inflammatory bowel disease (IBD) share many of the same clinical risk factors for the development of C difficile-associated disease. Many IBD patients are maintained on long-term immunosuppression, frequently require antibiotic use for their treatment, and are often hospitalised.
Clostridium difficile infection (CDI) has been increasing in incidence among those with underlying IBD and is associated with substantial morbidity, the need for surgery, and even mortality. Research has shown that IBD patients with co-existent CDI are hospitalised for substantially longer, with a median length of stay of 26 days compared with just five days for patients with IBD alone. Overall, CDI is estimated to cost the EU €3 billion per annum and this cost is expected to almost double over the next four decades.
An international consensus project involving a multidisciplinary group of clinicians was presented recently at The European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) 2016. This report highlighted the need for improved management of CDI in IBD patients.
The consensus specifically examined the issues impacting clinical professionals working with CDI and aimed to understand the perceptions and attitudes of key stakeholders regarding best practice in the management of CDI in patients with IBD. A survey of 426 international healthcare professionals, including infectious disease specialists, microbiologists, and gastroenterologists, was carried out and recommendations were developed based on the consensus scores.
The survey showed that although members from all participating medical disciplines equally recognised the importance of infections with C. difficile as critical events in the course of IBD, the diagnostic and treatment strategies varied significantly between different specialists.
Both CDI and IBD flares often present with similar symptoms but have markedly divergent management plans. Treatment of CDI requires directed antibiotic therapy with minimising immunosuppression, while the management of an IBD flare involves escalation in immunosuppressive therapy. Thus, it is important for the treating clinician to have a high index of suspicion for CDI in IBD patients, and to initiate early testing and appropriate therapy.
The results of this study underline the urgent need for interdisciplinary controlled studies aiming to optimise and harmonise treatment strategies for C. difficile in patients with IBD. Clinically, CDI negatively impacts IBD patients, and a majority require hospitalisation for management. In summary, clinicians must be vigilant regarding the potential for C. difficile to contribute to colitis flare in order to rapidly identify and optimally treat IBD patients.