Patients with inflammatory bowel disease (IBD) have an increased risk of Clostridioides difficile infection (CDI), which can lead to worse IBD outcomes. The diagnosis of CDI in patients with IBD is complicated by higher C. difficile colonization rates and shared clinical symptoms of intestinal inflammation. Traditional risk factors for CDI, such as antibiotic exposure, may be lacking in patients with IBD because of underlying intestinal microbiota dysbiosis. Although CDI disproportionately affects people with IBD, patients with IBD are typically excluded from CDI clinical trials creating a knowledge gap in the diagnosis and management of these 2 diseases. This narrative review aims to provide a comprehensive overview of the diagnosis, treatment, and prevention of CDI in patients with IBD. Distinguishing CDI from C. difficile colonization in the setting of an IBD exacerbation is important to avoid treatment delays. When CDI is diagnosed, extended courses of anti- C. difficile antibiotics may lead to better CDI outcomes. Regardless of a diagnosis of CDI, the presence of C. difficile in a patient with IBD should prompt a disease assessment of the underlying IBD. Microbiota-based therapies and bezlotoxumab seem to be effective in preventing CDI recurrence in patients with IBD. Patients with IBD should be considered at high risk of CDI recurrence and evaluated for a preventative strategy when diagnosed with CDI. Ultimately, the comanagement of CDI in a patient with IBD requires a nuanced, patient-specific approach to distinguish CDI from C. difficile colonization, prevent CDI recurrence, and manage the underlying IBD.

中文翻译：

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炎症性肠病中艰难梭菌的诊断和管理。


炎症性肠病 （IBD） 患者患艰难梭菌感染 （CDI） 的风险增加，这可能导致更糟糕的 IBD 结果。IBD 患者 CDI 的诊断因艰难梭菌定植率较高和共同的肠道炎症临床症状而复杂。由于潜在的肠道微生物群失调，IBD 患者可能缺乏 CDI 的传统危险因素，例如抗生素暴露。尽管 CDI 对 IBD 患者的影响不成比例，但 IBD 患者通常被排除在 CDI 临床试验之外，这在这两种疾病的诊断和管理方面造成了知识差距。本叙述性综述旨在全面概述 IBD 患者 CDI 的诊断、治疗和预防。在 IBD 加重的情况下，区分 CDI 和艰难梭菌定植对于避免治疗延误很重要。当诊断为 CDI 时，延长抗艰难梭菌抗生素疗程可能会带来更好的 CDI 结果。无论 CDI 的诊断如何，IBD 患者存在艰难梭菌都应促使对潜在的 IBD 进行疾病评估。基于微生物群的疗法和 bezlotoxumab 似乎可有效预防 IBD 患者的 CDI 复发。IBD 患者应被视为 CDI 复发的高风险患者，并在诊断为 CDI 时评估预防策略。最终，IBD 患者 CDI 的共同管理需要一种细致入微的、针对患者的方法来区分 CDI 与艰难梭菌定植，防止 CDI 复发，并管理潜在的 IBD。