Clostridium difficile infection (CDI) is associated with increased mortality in inflammatory bowel disease (IBD), but the risk of colectomy is variable, and has not been adequately studied.
Dr McCurdy and colleagues from Canada performed a systematic review and meta-analysis to assess the impact of CDI on colectomy risk in IBD.
Multiple databases were searched systematically for observational studies reporting colectomy risk in IBD, stratified by the presence of CDI, and the duration of follow-up.
The research team identified 12 observational studies, and included 35,057 IBD patients with CDI, and 929,259 without CDI.
|CDI was associated with higher long-term colectomy risk in ulcerative colitis|
|Alimentary Pharmacology & Therapeutics|
The researchers found that CDI did not increase the short-term colectomy risk in IBD patients overall, or in patients with ulcerative colitis.
In contrast, the team noted that CDI was associated with higher long-term colectomy risk in patients with IBD overall, and in patients with ulcerative colitis.
The results were stable in subgroups stratified by recruitment period, hospitalization status and geographical location.
The team reported that all studies were at least of moderate quality.
The results were limited in the ability to compare IBD severity, and the type of anti-microbial therapy.
Dr McCurdy's team concludes, "Based on 12 observational studies with at least moderate quality, Clostridium difficile infection appears to increase colectomy risk in IBD in the long- but not short- term."