Infliximab use in ulcerative colitis flare with clostridium difficile infection: A report of two cases and literature review

摘要

Inflammatory bowel disease (IBD) patients, especially those with ulcerative colitis (UC), are at a high risk of developing Clostridium difficile infection (CDI) and related complications. CDI has been reported in 1.8%–5.7% of the patients hospitalized for UC [ 1 ]. IBD patients with CDI have poor outcomes with increased severity of relapse, longer hospital stay, and high rates of colectomy and mortality [ 2 ]. Approximately 10% of IBD patients develop CDI at the time of diagnosis or during the course of their disease [ 3 , 4 ]. Colon involvement increases the risk of CDI by several fold compared with small bowel disease. Probably due to this reason, UC patients have a higher risk of developing CDI compared to Crohn’s disease (CD) patients [ 1 ]. IBD patients also have a higher rate (8% vs 1%) of asymptomatic carriage of C. difficile than the general healthy population [ 5 ]. The management of CDI in IBD, not responding to antibiotics, is a challenge.