C. difficile is a naturally occurring gut bacteria which is harmless, until the gut bacteria balance gets altered by antibiotics, allowing C. difficile to multiply. This is when it becomes an infection, leading to diarrhea and potentially causing serious bowel issues. Many cases of C. difficile infections occur in a healthcare setting because of their links to antibiotic therapy.
As mentioned in my previous article, a C. difficile infection (CDI) can be incredibly destabilising for IBD patients and can cause flare-ups even in patients who had previously been in deep remission. Hence, to know more about CDI and IBD, I attended the AIBD 2020 CME Symposium on ‘Optimal Management of Clostridium Difficile Infection (CDI) and CDI Recurrence in Patients With IBD’.
The first talk in the symposium was given by Dr Sahil Khanna on the epidemiology, risk factors, and diagnosis of C. difficile infections in IBD patients, and here are the key takeaways from his presentation -
The number of patients with C. diff infections is rising every year, and so is the proportion of patients with both IBD and C. diff.
The risk of recurrent C. diff infections is higher for patients with IBD compared to patients that do not have IBD.
Risk factors for CDI in IBD - antibiotic use, prior CDI, colonic disease, active/uncontrolled IBD, active immunosuppression (biologics), chemotherapy, long-term hospitalisation, surgery
Patients with IBD and CDI are more likely to not respond to IBD therapy, undergo surgery, have more frequent ER visits/hospitalizations, greater recurrence and mortality rates, and incur higher healthcare costs compared to IBD patients with no CDI.
All IBD patients with a flare should be tested for CDI because of overlapping symptoms.
A PCR test is insufficient for testing CDI. A 2-step algorithm comprising of GDH and EIA is desirable.
The second talk in the symposium was given by Dr Ari Grinspan on the treatment of CDI, and the important points of his presentation, from a patient perspective, are listed below -
IBD patients are at a very high risk of CDI recurrence.
FMT is a safe and effective option for treating recurrent CDI. It has a cure rate of 80-90% among IBD patients with recurrent CDI and the probability of a post-FMT IBD flare is very low. It also improves the microbiome diversity.
FMT should be done earlier, perhaps after a 1st recurrence of CDI, for better long-term results.
Escalation of IBD therapy after a C. diff infection is safe.
COVID hasn’t increased CDI rates, but patients with diarrhoea should be checked for CDI.
OpenBiome (stool bank) is on a temporary clinical hold because of COVID, hence, FMT for recurrent CDI is on hold at many centres.
The symposium concluded with case discussions and a Q/A session, of which an important point to note was
Probiotics have no role in the treatment of CDI among patients with IBD. Recent research has shown that probiotics may not only be ineffective at preventing recurrence but may even cause harm.
The symposium, although directed at clinicians, was enlightening to me as a patient. Chronic illness takes over almost every aspect of our lives, and as a patient, the more knowledge and information we have about what we are dealing with, potential scenarios, control measures, the more we feel at ease and are able to move forward with life without having a constant fear of the unknown. This information is even more valuable to patients living in regions with substandard healthcare facilities and/or are financially strained. I’ve thoroughly enjoyed AIBD 2020 so far, and even though many sessions have been technical, it has really increased my understanding of my condition, and also made me aware of my own lapses in self-care. I hope this article helps you in similar and other ways.
Thank you! Stay safe :)