Background: The rising incidence of Clostridium difficile infection (CDI) in the general
population has been recognized by health care organizations worldwide. The emergence of hypervirulent
strains has made CDI more challenging to understand and treat. Inflammatory bowel disease (IBD)
patients are at higher risk of infection, including CDI.
Objective: A diagnostic approach for recurrent CDI has yet to be validated, particularly for IBD patients.
Enzyme immunoassay (EIA) for toxins A and B, as well as glutamate dehydrogenase EIA, are
both rapid testing options for the identification of CDI. Without a high index of suspicion, it is challenging
to initially differentiate CDI from an IBD flare based on clinical evaluation alone.
Methods: Here, we provide an up-to-date review on CDI in IBD patients. When caring for an IBD
patient with suspected CDI, it is appropriate to empirically treat the presumed infection while awaiting
further test results.
Results: Treatment with vancomycin or fidaxomicin, but not oral metronidazole, has been advocated
by an expert review from the clinical practice update committee of the American Gastroenterology
Association. Recurrent CDI is more common in IBD patients compared to non-IBD patients (32%
versus 24%), thus more aggressive treatment is recommended for IBD patients along with early consideration
of fecal microbiota transplant.
Conclusion: Although the use of infliximab during CDI has been debated, clinical experience exists
supporting its use in an IBD flare, even with active CDI when needed.