Does early corticosteroid therapy affect prognosis in IBD patients hospitalized with Clostridioides difficile infection?
Adrenal Cortex Hormones
/ adverse effects
Adult
Anti-Bacterial Agents
/ therapeutic use
Cause of Death
Clostridium Infections
/ complications
Colectomy
Female
Humans
Inflammatory Bowel Diseases
/ complications
Kaplan-Meier Estimate
Male
Middle Aged
Patient Readmission
Prognosis
Retrospective Studies
Risk Factors
Time-to-Treatment
Antibiotics
Clostridioides difficile
Corticosteroids
Inflammatory bowel disease
Journal
International journal of colorectal disease
ISSN: 1432-1262
Titre abrégé: Int J Colorectal Dis
Pays: Germany
ID NLM: 8607899
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
accepted:
29
12
2019
pubmed:
14
1
2020
medline:
20
11
2020
entrez:
14
1
2020
Statut:
ppublish
Résumé
Corticosteroids (CS) therapy to Clostridioides difficile infection (CDI) in inflammatory bowel disease (IBD) flares may worsen CDI outcomes. Assess the impact of early CS exposure on outcomes of IBD patients diagnosed with CDI. Retrospective study of IBD patients admitted with first-time CDI between 2002 and 2018. Comparisons were made based on CS exposure 48 h from admission. Patients were further subdivided to 5 groups based on CS-antibiotics temporal exposure. The primary outcome was all-cause mortality or colectomy within 3 months. Secondary outcomes were colectomy and mortality rates at 1 year, length of stay, readmissions, bacteremia, and diarrhea improvement by day 7/discharge. Cox proportional hazard model and Kaplan-Meier curves were used to assess the effects on survival. Logistic and ordinal regressions were used to assess primary and secondary outcomes. One hundred thirteen patients (64 CD, 46 UC, and 3 IBDU) were included, 82 (72.5%) received early CS. At baseline, CRP was significantly lower and albumin was higher in the group not exposed to early CS. At 3 months, 4 (4.8%) patients required colectomy and 6 (5.8%) died (p = NS). Length of stay was significantly reduced among patients not exposed to early CS. All other endpoints were not associated with CS exposure. In subgroup analysis, the primary outcome was not significantly different among the sub-groups. Mortality rate at 1 year was significantly lower in patients who did not receive antibiotics for CDI. Early CS therapy in IBD patients hospitalized with CDI is not associated with worse clinical outcomes. However, additional prospective research is required.
Sections du résumé
BACKGROUND
BACKGROUND
Corticosteroids (CS) therapy to Clostridioides difficile infection (CDI) in inflammatory bowel disease (IBD) flares may worsen CDI outcomes.
AIM
OBJECTIVE
Assess the impact of early CS exposure on outcomes of IBD patients diagnosed with CDI.
METHODS
METHODS
Retrospective study of IBD patients admitted with first-time CDI between 2002 and 2018. Comparisons were made based on CS exposure 48 h from admission. Patients were further subdivided to 5 groups based on CS-antibiotics temporal exposure. The primary outcome was all-cause mortality or colectomy within 3 months. Secondary outcomes were colectomy and mortality rates at 1 year, length of stay, readmissions, bacteremia, and diarrhea improvement by day 7/discharge. Cox proportional hazard model and Kaplan-Meier curves were used to assess the effects on survival. Logistic and ordinal regressions were used to assess primary and secondary outcomes.
RESULTS
RESULTS
One hundred thirteen patients (64 CD, 46 UC, and 3 IBDU) were included, 82 (72.5%) received early CS. At baseline, CRP was significantly lower and albumin was higher in the group not exposed to early CS. At 3 months, 4 (4.8%) patients required colectomy and 6 (5.8%) died (p = NS). Length of stay was significantly reduced among patients not exposed to early CS. All other endpoints were not associated with CS exposure. In subgroup analysis, the primary outcome was not significantly different among the sub-groups. Mortality rate at 1 year was significantly lower in patients who did not receive antibiotics for CDI.
CONCLUSION
CONCLUSIONS
Early CS therapy in IBD patients hospitalized with CDI is not associated with worse clinical outcomes. However, additional prospective research is required.
Identifiants
pubmed: 31927638
doi: 10.1007/s00384-019-03502-z
pii: 10.1007/s00384-019-03502-z
doi:
Substances chimiques
Adrenal Cortex Hormones
0
Anti-Bacterial Agents
0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
513-519Références
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