Journal of Gastroenterology and Hepatology

Volume 39, Issue 11 pp. 2417-2423

Original Article - Gastroenterology (Clinical)

Antibiotic use and risk of Clostridioides difficile infection in patients with inflammatory bowel disease

Alexis Bejcek,

Corresponding Author

Alexis Bejcek

[email protected]

orcid.org/0000-0003-2191-2757

Division of Gastroenterology, Department of Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA

Correspondence

Alexis Bejcek, Division of Gastroenterology, Department of Medicine, Baylor Scott & White Medical Center, 1605 S 31st St, Temple, TX 76508, USA.

Email: [email protected]

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Anupama Ancha,

Anupama Ancha

Division of Internal Medicine, Department of Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA

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Megan Lewis,

Megan Lewis

Division of Gastroenterology, Department of Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA

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Ryan Beaver,

Ryan Beaver

Division of Infectious Diseases, Department of Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA

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Kristen Tecson,

Kristen Tecson

Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas, USA

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Jaccallene Bomar,

Jaccallene Bomar

Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas, USA

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Christopher Johnson,

Christopher Johnson

Division of Gastroenterology, Department of Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA

Department of Medicine, Baylor College of Medicine, Temple, Texas, USA

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Alexis Bejcek,

Corresponding Author

Alexis Bejcek

[email protected]

orcid.org/0000-0003-2191-2757

Division of Gastroenterology, Department of Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA

Correspondence

Alexis Bejcek, Division of Gastroenterology, Department of Medicine, Baylor Scott & White Medical Center, 1605 S 31st St, Temple, TX 76508, USA.

Email: [email protected]

Search for more papers by this author

Anupama Ancha,

Anupama Ancha

Division of Internal Medicine, Department of Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA

Search for more papers by this author

Megan Lewis,

Megan Lewis

Division of Gastroenterology, Department of Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA

Search for more papers by this author

Ryan Beaver,

Ryan Beaver

Division of Infectious Diseases, Department of Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA

Search for more papers by this author

Kristen Tecson,

Kristen Tecson

Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas, USA

Search for more papers by this author

Jaccallene Bomar,

Jaccallene Bomar

Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas, USA

Search for more papers by this author

Christopher Johnson,

Christopher Johnson

Division of Gastroenterology, Department of Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA

Department of Medicine, Baylor College of Medicine, Temple, Texas, USA

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First published: 15 August 2024

https://doi.org/10.1111/jgh.16720

Citations: 1

Declaration of conflict of interest: The authors have no conflicts of interest to disclose.

Informed consent: Not applicable.

Financial support: Support was provided through internal funding from the Baylor Scott & White Research Institute.

Clinical trial registration: This study was not registered within a clinical trial.

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Abstract

Background and Aim

Patients with inflammatory bowel disease (IBD) have an increased risk of Clostridioides difficile infection (CDI) compared with those without IBD, which is worsened with antibiotic usage. While prior studies have shown a correlation between CDI development and certain classes of antibiotics, the IBD population has not been well represented. This study evaluates the rates of CDI with outpatient antibiotic use in patients with IBD.

Methods

We conducted a retrospective cohort study composed of patients with IBD and compared the incidence of CDI in patients who received an outpatient prescription for antibiotics (6694 patients) against those without prescriptions (6025 patients) from 2014 to 2020 at our institution. We compared CDI rates based on nine antibiotic classes: penicillins, cephalosporins, sulfonamides, tetracyclines, macrolides, quinolones, clindamycin, metronidazole, and nitrofurantoin.

Results

The risk of CDI was low (0.7%) but significantly higher for those with antibiotic exposure (0.9% vs 0.5%, P = 0.005) and had a positive correlation with a smoking history. The increased risk of CDI in the IBD population was attributable to the clindamycin and metronidazole classes (odds ratio = 4.7, 95% confidence interval: 1.9–11.9, P = 0.001; odds ratio = 3.6, 95% confidence interval: 2.1–6.2, P < 0.0001, respectively).

Conclusions

The use of clindamycin or metronidazole prescribed in an outpatient setting was associated with a statistically significant increased risk of CDI in patients with IBD. Although the association between clindamycin and CDI is a well-established and common finding, the association between metronidazole and CDI is unique in this study.

Graphical Abstract

Open Research

Data availability statement

The data collected and used for this manuscript are readily available per request. Please contact the corresponding author for details.

Supporting Information

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Citing Literature

Volume39, Issue11

November 2024

Pages 2417-2423