Tailored Treatment Strategies for Clostridiodes Difficile Infection and Recurrence in IBD

In my presentation on the topic of C. difficile infections among patients with inflammatory bowel disease at the AIBD virtual regional meeting on June 19, I made the following key points to provide a take-home message.

As gastroenterologists, we all see inflammatory bowel disease in our practice, and especially with the increased incidence of the C. diff infections, we see IBD patients who also have frequent C. diff infections, which tend to be recurrent among this population.

What I want to emphasize is that we all need to know that C. diff infection among IBD patients tends to have a much worse outcome. Our patients with C diff often have more frequent IBD flares, are refractory to medical treatment, need more frequent escalation of IBD therapies, and they tend to have higher rates of surgery, mortality rate, and emergency room visits. They also have longer hospital stays and increased health care costs.

We need to be aware that the medication treatment also changes with time, especially now that there have been changes in practice guidelines that have taken metronidazole out of the recommended medications, especially for patients with IBD and C. diff infection, because of drug resistance. Vancomycin and fidaxomicin are more favored as current C. diff treatments.

I want to mention that fecal transplantation, which has been actively practiced for the past 20 years in the United States for treating C. diff infections, can also be very effective among IBD population. However, we do need to be aware that the IBD patients tend to have a risk of flares after fecal transplant, based on the current available data.

New medical treatment for the prevention of recurrent C. diff are being studied, although those studies are not necessarily performed within IBD populations, but more on a general population. Two medications appear to be beneficial—one is bezlotoxumab and the other is the RBX2660. Of course, these will be potential options for patients who are not candidate for a fecal transplants, or perhaps these medications can be used early on in the disease course, to prevent a second recurrence.

Those are the critical points for my talk on the topic of C. diff infections in IBD patients. I hope this information will be helpful for your future practice.