Combination immunomodulator and antibiotic treatment in patients with inflammatory bowel disease and clostridium difficile infection
| Autor: | Ben-Horin, Shomron, Margalit, Maya, Bossuyt, Peter, Maul, Jochen, Shapira, Yami, Bojic, Daniela, Chermesh, Irit, Al-Rifai, Ahmad, Schoepfer, Alain, Bosani, Matteo, Allez, Matthieu, Lakatos, Peter Laszlo, Bossa, Fabrizio, Eser, Alexander, Stefanelli, Tommaso, Carbonnel, Franck, Katsanos, Konstantinos, Checchin, Davide, Miera, Inés Sáenz De, Chowers, Yehuda, Moran, Gordon William, Renseigné, Non |
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| Přispěvatelé: | Agents pathogènes et inflammation - UFC (EA 4266) (API), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC) |
| Jazyk: | angličtina |
| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_treatment MESH: Hospitalization Gastroenterology Inflammatory bowel disease Severity of Illness Index 0302 clinical medicine Crohn Disease Risk Factors MESH: Risk Factors Odds Ratio Medicine Colectomy Enterocolitis Pseudomembranous MESH: Treatment Outcome Enterocolitis MESH: Middle Aged MESH: Immunologic Factors Clostridium difficile Middle Aged Ulcerative colitis 3. Good health Anti-Bacterial Agents Hospitalization Treatment Outcome 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Drug Therapy Combination Female medicine.symptom Adult medicine.medical_specialty Combination therapy MESH: Colitis Ulcerative MESH: Enterocolitis Pseudomembranous MESH: Multivariate Analysis 03 medical and health sciences Pharmacotherapy Internal medicine MESH: Anti-Bacterial Agents MESH: Severity of Illness Index Humans Immunologic Factors Colitis MESH: Clostridium difficile Retrospective Studies MESH: Colectomy MESH: Humans Hepatology MESH: Crohn Disease business.industry Clostridioides difficile MESH: Adult MESH: Retrospective Studies [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology medicine.disease MESH: Male MESH: Odds Ratio Surgery MESH: Drug Therapy Combination Multivariate Analysis Colitis Ulcerative business MESH: Female |
| Zdroj: | Clinical Gastroenterology and Hepatology Clinical Gastroenterology and Hepatology, WB Saunders, 2009, 7 (9), pp.981-7. ⟨10.1016/j.cgh.2009.05.031⟩ |
| ISSN: | 1542-3565 |
| DOI: | 10.1016/j.cgh.2009.05.031⟩ |
| Popis: | International audience; 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, 2.1-29; 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. |
| Databáze: | OpenAIRE |
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