Clostridium innocuum infection in hospitalised patients with inflammatory bowel disease
Introduction
Patients with inflammatory bowel disease (IBD) are more likely to develop severe Clostridioides difficile (CD) infection than the general population.1, 2, 3, 4 Such infection can lead to poor outcomes including IBD flare, colectomy, and even death. Additionally, patients with IBD who undergo successful treatment are 33% more likely to experience recurrence, compared with the general population.5 Clostridium innocuum (CI) is a Gram-positive, vancomycin-resistant, spore-forming member of the commensal microbiota. CI infection, first described in 1961,6 has been reported to be associated with recurrent diarrhea in patients with prior CD-associated diarrhea.7 Furthermore, CI infection can cause antibiotic-associated diarrhea, severe colitis, and extraintestinal infection.8,9 A recent study has found that CI can translocate to the mesenteric adipose tissue and promote the formation of creeping fat and intestinal stricture in Crohn's disease.10 Despite its potential importance as a pathogen in IBD, its risk factors, prevalence, clinical manifestations, treatments, and outcomes of CI infection in patients with IBD have not been studied before. Hence, this study aims to provide such information.
Section snippets
Compliance with ethical standards
The Institutional Review Board (IRB) of the Chang Gung Medical Foundation approved the study protocol (approval document No. 202101234B0). The IRB also waived the requirement of signed informed consent from patients for review of medical records in the electronic medical record system because of the retrospective nature of the study. The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki, as reflected in the prior approval by the institution's human research
Baseline characteristics of inpatients with IBD with Clostridium innocuum infection
We enrolled a total of 90 patients, including 22, 39, 13, and 16 patients in the CI, control, coinfection, and CD groups, respectively (Fig. 1). Records showed incidence rates of CI (CI+) and CD (CD+) at 39% (35 patients) and 32% (29 patients), respectively. After comparing the clinical characteristics of the CI and control groups, we found that patients in the CI group either had Crohn's disease (55%) or ulcerative colitis (45%). Also, patients in this group were mostly male (68.2%) with
Discussion
The incidence rates of CD infection in adult inpatients for Crohn's disease and ulcerative colitis were 1.0%–7.7% and 2.8%–11.1%.11 These numbers increased two- to three-fold in early 2000s. Back then, risk factors included colonic involvement and use of biologicals and antibiotics.12,13 Additionally, CD infection led to higher risks of subsequent escalation in IBD medical therapy, urgent colectomy, hospitalization, and mortality.11 On the other hand, CI also caused antibiotic-associated
Sample data availability statements
The data underlying this article will be shared on reasonable request to the corresponding author.
Funding
This study was funded by the Ministry of Health and Welfare, Taiwan (MOHW110-TDU-B-212–124005). The study was supported in part by Chang Gung Memorial Hospital, Taiwan (CMRPG3L0471).
CRediT authorship contribution statement
Puo-Hsien Le: Project administration, Visualization, Writing – review & editing, Data curation, Writing – original draft. Cheng-Tang Chiu: Project administration, Visualization. Pai-Jui Yeh: Data curation, Formal analysis. Yu-Bin Pan: Data curation, Formal analysis. Cheng-Hsun Chiu: Project administration, Visualization, Writing – review & editing, Data curation.
Declaration of Competing Interest
All authors have no conflicts of interest to disclose.
Acknowledgments
The authors acknowledge the statistical assistance provided by the Clinical Trial Center, Chang Gung Memorial Hospital, Linkou Branch, Taiwan.
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