AGA Clinical Practice Update on Management of Clostridioides difficile Infection in Inflammatory Bowel Disease: Expert Review - PubMed
2 hours ago
- #Clostridioides difficile infection
- #Microbiome therapy
- #Inflammatory bowel disease
- Clostridioides difficile infection (CDI) is a major cause of disease flares and poor outcomes in inflammatory bowel disease (IBD), leading to higher hospitalization, therapy failure, and surgical rates.
- Patients with IBD have greater risk, severity, and recurrence of CDI compared to the non-IBD population.
- Diagnosis should exclude CDI in IBD patients with new or worsening diarrhea, especially those with colonic involvement.
- Use multistep toxin-based assays for suspected CDI in IBD patients.
- For initial CDI episodes, prefer fidaxomicin or vancomycin; avoid metronidazole.
- Hospitalization is advised for severe colitis or systemic toxicity (e.g., >6 bowel movements/day, severe pain, leukocytosis, sepsis).
- Continue immunosuppressive IBD therapies during acute CDI; steroids can be used if necessary.
- Consider endoscopic evaluation if symptoms persist 48-72 hours after CDI treatment to check IBD activity and exclude cytomegalovirus.
- Microbiome-based therapies (e.g., fecal microbiota transplantation) are recommended for recurrent CDI in IBD patients.
- Avoid probiotics for primary or secondary CDI prevention in IBD patients.
- Oral vancomycin prophylaxis may be considered for secondary prevention in IBD patients with CDI history on antibiotics.