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IBD Patients Often Not Tested for C. Difficile Infection
By David Douglas
NEW YORK (Reuters Health) - Many patients with diarrhea diagnosed with inflammatory bowel disease (IBD) are not routinely checked for Clostridium difficile infection (CDI), researchers have found.
"Testing for CDI in IBD patients with diarrhea is critical, but unfortunately is not always done," Dr. Samir A. Shah of Brown University in Providence, Rhode Island, told Reuters Health by email. "Our study shows only about half of patients were tested and this is (a) quality issue that needs highlighting to improve the quality of care for IBD."
It's possible that some of these patients may have symptoms because of CDI rather than IBD, and CDI may also trigger "a flare of IBD or worsen existing IBD symptoms and worsen disease course (for example, higher rates of colectomy in UC patients who are hospitalized with a flare)," added Dr. Shah.
Among a state-based cohort of 320 patients newly diagnosed with IBD, 71% reported diarrhea, Dr. Shah and colleagues found. And just 50% of these patients were tested for CDI, they report in Inflammatory Bowel Disease, online January 9.
Another 24 patients who did not have diarrhea were tested for CDI. There was no record of CDI testing in the remaining 114. Of the 137 tested patients, seven (5.1%) were positive for CDI.
Based on the data, say the researchers, "there does seem to be some increase in CDI testing over time" -- from 31.6% in 2008 to 50% in 2011 -- "which may account for an increasing awareness of CDI in recent years."
CDI testing might be improved, the researchers conclude, "through increased education to those caring for patients with IBD, direct education of patients with IBD, and also through the incorporation of CDI testing as part of the Physician Quality Reporting Initiative."
Commenting on the findings by email, Dr. David G. Binion told Reuters Health, "This is an important study from a population-based registry, demonstrating that C. difficile infection is frequently seen in IBD patients at the time of diagnosis, occurring in 5% of patients."
Dr. Binion, co-director of the Inflammatory Bowel Disease Center at UPMC Presbyterian Hospital, Pittsburgh, added that, "The study demonstrates that half of the newly diagnosed IBD patients did not undergo fecal testing for infections at the time of diagnosis. This is problematic, as patients who are treated with potent immunosuppression (including steroids) can have clinical deterioration with a superimposed C. difficile infection. There is an important message, that testing for C. difficile is not being performed in half of the IBD patients at a time when this is appropriate."
"C. difficile testing can be easily incorporated into the diagnostic colonoscopy, by placing a trap on the colonoscope and sampling fluid directly from the colon for analysis," Dr. Binion said. "This gives a more reliable collection sample and should be recommended in all patients undergoing an initial diagnostic colonoscopy. Optimizing treatment for patients requires making the diagnosis of superimposed infection, which has an immediate and long-term impact on IBD patients' health."
SOURCE: https://bit.ly/1LIdXum
Inflamm Bowel Dis 2015.
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