Risk factors for Clostridioides difficile infection among patients diagnosed with inflammatory intestinal and rheumatological diseases in the biologic era
Abstract Background Clostridioides difficile infection (CDI) in inflammatory bowel disease (IBD) has been associated with poor clinical outcomes. The relationship between biologic therapy and CDI is controversial. We aimed to assess whether biologic therapy increases CDI risk among IBD patients, to...
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2025-02-01
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| Series: | BMC Gastroenterology |
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| Online Access: | https://doi.org/10.1186/s12876-025-03650-3 |
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| author | Helena Martínez-Lozano Paula Saralegui-Gonzalez Elena Reigadas Pablo Ramón Fueyo-Peláez Aurea García-García José Miranda-Bautista Luis Alcalá Juan Carlos Nieto María Elena Lobato-Matilla Ignacio Marín-Jiménez Patricia Muñoz Luis Menchén |
| author_facet | Helena Martínez-Lozano Paula Saralegui-Gonzalez Elena Reigadas Pablo Ramón Fueyo-Peláez Aurea García-García José Miranda-Bautista Luis Alcalá Juan Carlos Nieto María Elena Lobato-Matilla Ignacio Marín-Jiménez Patricia Muñoz Luis Menchén |
| author_sort | Helena Martínez-Lozano |
| collection | DOAJ |
| description | Abstract Background Clostridioides difficile infection (CDI) in inflammatory bowel disease (IBD) has been associated with poor clinical outcomes. The relationship between biologic therapy and CDI is controversial. We aimed to assess whether biologic therapy increases CDI risk among IBD patients, to identify factors associated with increased CDI risk, and to characterize CDI episodes in our population. Methods We included patients diagnosed with IBD (IBD-cohort) and immune-mediated inflammatory rheumatic diseases (Rheuma-cohort). Risk factors for CDI were assessed using a logistic regression model. We also estimated the incidence rate of CDI for each biologic. Results We included 1866 patients: 1041 from the IBD-cohort and 825 from the Rheuma-cohort. The diagnosis of IBD was the major risk factor for developing CDI in the overall population (OR: 18.29, CI 95%: 5.59–59.80, p < 0.001). Within the IBD-cohort, patients with ulcerative colitis had an increased risk for CDI compared to Crohn’s disease (OR:2.00, 95% CI: 1.18–3.42, p = 0.011). Although the subgroup of IBD patients receiving biologics showed a higher incidence of CDI compared to unexposed IBD patients, biologic therapy was not an independent risk factor for CDI in the logistic regression model; nevertheless, patients who received 3 or more biologic agents had a significantly higher risk for CDI (OR: 3.09, CI 95% 1.13–8.47, p = 0.028). Conclusions IBD significantly increases the risk of CDI among patients treated with biologic therapy; although such treatments do not seem to individually increase the risk, the number of biologics received may be a new predictor of CDI. |
| format | Article |
| id | doaj-art-a7c438f496e2492fa3ae0cc43af4adde |
| institution | Kabale University |
| issn | 1471-230X |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
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| series | BMC Gastroenterology |
| spelling | doaj-art-a7c438f496e2492fa3ae0cc43af4adde2025-02-09T12:39:35ZengBMCBMC Gastroenterology1471-230X2025-02-0125111010.1186/s12876-025-03650-3Risk factors for Clostridioides difficile infection among patients diagnosed with inflammatory intestinal and rheumatological diseases in the biologic eraHelena Martínez-Lozano0Paula Saralegui-Gonzalez1Elena Reigadas2Pablo Ramón Fueyo-Peláez3Aurea García-García4José Miranda-Bautista5Luis Alcalá6Juan Carlos Nieto7María Elena Lobato-Matilla8Ignacio Marín-Jiménez9Patricia Muñoz10Luis Menchén11Department of Digestive System Medicine, Hospital General Universitario Gregorio Marañón - Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)Department of Digestive System Medicine, Hospital General Universitario Gregorio Marañón - Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)Department of Microbiology, Hospital General Universitario Gregorio MarañónDepartment of Digestive System Medicine, Hospital General Universitario Gregorio Marañón - Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)Department of Digestive System Medicine, Hospital General Universitario Gregorio Marañón - Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)Department of Digestive System Medicine, Hospital General Universitario Gregorio Marañón - Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)Department of Microbiology, Hospital General Universitario Gregorio MarañónDepartment of Rheumatology, Hospital General Universitario Gregorio MarañónDepartment of Pharmacy Hospital General, Universitario Gregorio Marañón - Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)Department of Digestive System Medicine, Hospital General Universitario Gregorio Marañón - Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)Department of Microbiology, Hospital General Universitario Gregorio MarañónDepartment of Digestive System Medicine, Hospital General Universitario Gregorio Marañón - Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)Abstract Background Clostridioides difficile infection (CDI) in inflammatory bowel disease (IBD) has been associated with poor clinical outcomes. The relationship between biologic therapy and CDI is controversial. We aimed to assess whether biologic therapy increases CDI risk among IBD patients, to identify factors associated with increased CDI risk, and to characterize CDI episodes in our population. Methods We included patients diagnosed with IBD (IBD-cohort) and immune-mediated inflammatory rheumatic diseases (Rheuma-cohort). Risk factors for CDI were assessed using a logistic regression model. We also estimated the incidence rate of CDI for each biologic. Results We included 1866 patients: 1041 from the IBD-cohort and 825 from the Rheuma-cohort. The diagnosis of IBD was the major risk factor for developing CDI in the overall population (OR: 18.29, CI 95%: 5.59–59.80, p < 0.001). Within the IBD-cohort, patients with ulcerative colitis had an increased risk for CDI compared to Crohn’s disease (OR:2.00, 95% CI: 1.18–3.42, p = 0.011). Although the subgroup of IBD patients receiving biologics showed a higher incidence of CDI compared to unexposed IBD patients, biologic therapy was not an independent risk factor for CDI in the logistic regression model; nevertheless, patients who received 3 or more biologic agents had a significantly higher risk for CDI (OR: 3.09, CI 95% 1.13–8.47, p = 0.028). Conclusions IBD significantly increases the risk of CDI among patients treated with biologic therapy; although such treatments do not seem to individually increase the risk, the number of biologics received may be a new predictor of CDI.https://doi.org/10.1186/s12876-025-03650-3Clostridioides difficileInflammatory bowel diseaseImmune-mediated inflammatory diseasesBiologics |
| spellingShingle | Helena Martínez-Lozano Paula Saralegui-Gonzalez Elena Reigadas Pablo Ramón Fueyo-Peláez Aurea García-García José Miranda-Bautista Luis Alcalá Juan Carlos Nieto María Elena Lobato-Matilla Ignacio Marín-Jiménez Patricia Muñoz Luis Menchén Risk factors for Clostridioides difficile infection among patients diagnosed with inflammatory intestinal and rheumatological diseases in the biologic era BMC Gastroenterology Clostridioides difficile Inflammatory bowel disease Immune-mediated inflammatory diseases Biologics |
| title | Risk factors for Clostridioides difficile infection among patients diagnosed with inflammatory intestinal and rheumatological diseases in the biologic era |
| title_full | Risk factors for Clostridioides difficile infection among patients diagnosed with inflammatory intestinal and rheumatological diseases in the biologic era |
| title_fullStr | Risk factors for Clostridioides difficile infection among patients diagnosed with inflammatory intestinal and rheumatological diseases in the biologic era |
| title_full_unstemmed | Risk factors for Clostridioides difficile infection among patients diagnosed with inflammatory intestinal and rheumatological diseases in the biologic era |
| title_short | Risk factors for Clostridioides difficile infection among patients diagnosed with inflammatory intestinal and rheumatological diseases in the biologic era |
| title_sort | risk factors for clostridioides difficile infection among patients diagnosed with inflammatory intestinal and rheumatological diseases in the biologic era |
| topic | Clostridioides difficile Inflammatory bowel disease Immune-mediated inflammatory diseases Biologics |
| url | https://doi.org/10.1186/s12876-025-03650-3 |
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