The Elevated Risk of Recurrent Clostridioides Difficile Infection in Patients with Inflammatory Bowel Disease: a Systematic Review and Meta-analysis.

Background The association between inflammatory bowel disease (IBD) and the risk of recurrent Clostridioides difficile infection (rCDI) is still controversial. This systematic review and meta-analysis aims to clarify whether the risk of rCDI is associated with IBD based on published data. Methods A systematic review and meta-analysis was conducted in English and Chinese databases, covering all available publications until date 01/01/2020. The statistical analysis was performed by RevMan 5.3 and odds ratios (ORs) combined with 95% confidence intervals (CI) were calculated to explore the IBD-rCDI association. Results A total of 4,417 IBD cases and 355,769 control cases in 14 independent studies from 2007 to 2019 were included. Compared with non-IBD, IBD was associated with an increased risk of rCDI (OR = 1.63, CI = 1.09 - 2.43, p = 0.02). In addition, the risk of rCDI was particularly and significantly increased in IBD patients at the young age (≤ 50, OR = 1.58, CI = 1.02 - 2.44, p = 0.04), but not in patients at the old age (> 50, OR = 2.08, CI = 0.65 - 6.61, p = 0.21). Compared with Crohn's disease (CD), no significant differences existed in the risk of rCDI in ulcerative colitis (UC) (OR = 1.22, CI = 0.81 - 1.85, p = 0.34). Additionally, the risk of rCDI was not significantly different between UC and CD, in patients receiving FMT (OR = 1.41, CI = 0.65 - 3.06, p = 0.38) or no FMT treatment (OR = 1.16, CI = 0.71 - 1.88, p = 0.56). Conclusions The risk of rCDI was significantly increased in IBD patients, in particular in those age below 50. Compared with CD, no significant differences of the risk of rCDI was observed in UC.