Modern Medicine | 2016, Vol. 23, No. 2 109 Burden of Clostridium Difficile Infection in Inflammatory Bowel Disease Alina Constantin 1 , Madalina Ilie 1 , Daniela Tabacelia 1 , Bogdan Popa 2 , Gabriel Constantinescu 1 , Radu Tincu 3 , Radu Alexandru Macovei 3 1 Department of Gastroenterology, Clinical Emergency Hospital Bucharest, Romania 2 Department of Radiology, Clinical Emergency Hospital Bucha- rest, Romania 3 Department of ICU-Toxicology Clinical Emergency Hospital Bu- charest Corresponding author: Madalina Ilie Department of Gastroenterology, Clinical Emergency Hospital, Bucharest, Romania. E-mail: drmadalina@gmail.com Abstract Objectives: Over the past two decades has been a dramatic worldwide increase in both incidence and severity of Clostridium Difficile infection (CDI). Several studies showed worse clinical outcomes in Inflammatory Bowel Disease (IBD) patients with CDI, including longer hospital stay, higher colectomy and mortality rates than in those without CDI. The aim of our study was to evaluate the prevalence of Clostridium difficile infection in IBD patients and to evaluate the particularities of diagnosis and treatment. Methodology: We performed a retrospective study that included 15 patients from a group of 220 IBD patients admitted in the Gastroenterology Department of the Cli- nical Emergency Hospital Bucharest between 2013- 2016 having also Clostridium Difficile infection. Results: The patients mean age was 44.1 years. The prevalence of CDI in patients with inflammatory bowel disease was 6.81%. Patients with ulcerative colitis were more susceptible to CDI (86.6%), than those with Crohn’s disease (13.3%). We studied also the response to treatment. Metronidazole alone was effective in 33.3% of cases. Vancomycin combined with Metronidazole was effective in 60% of cases. Refractory CDI unresponsive to 48 hours of conven- tional therapy appeared in 6.6% of cases. The eradication was achieved only with Tigecycline and fecal microbio- ta transplant. Imunosupressive therapy was continued in all cases, concomitant with Metronidazole/Vancomicin. Conclusions: Patients with ulcerative colitis are at higher risk for CDI and have a poor prognosis than those with Crohn’s disease. Average age of CDI in IBD patients significantly is lower than in general population. In IBD patients, presenting with diarrhea or a change in bowel habits, practitioners need to test for C. difficile and differentiate CDI symptoms from a disease flare. Special care to rule out C. difficile should be pursued prior to escalating or starting new immunosuppressive agents. Fecal microbiota transplant, probiotics, and newer antibiotics are good alternati- ves for refractory disease. Keywords: Clostridium difficile, Inflammatory bowel disease, Ulcerative colitis, Crohn’s disease, antibiotic associa- ted diarrhea, Vancomycin, Metronidazole, Tigecycline, fecal transplantation. Rezumat Obiective: În ultimele 2 decenii s-a observat o creștere dramatică a incidenţei și severităţii infecţiei cu Clostridium Difficile. Câteva studii au arătat un prognostic clinic nefavorabil la pacienţii cu boli inflamatorii intestinale incluzând spitalizare prelungită, lipsa răspunsului la tratament, rate de de colectomie si mortalitate mai crescute decât la cei fără infecţie cu Clostridium difficile. Obiectivul studiului a fost de a evalua frecvenţa infecţiei cu Clostridium Difficile în rândul pacienţilor cu boala Crohn și Rectocolită ulcero-hemoragică și de asemenea de a evalua particularităţile de diagnostic și tratament. Material și metodă: Am efectuat un studiu retrospectiv ce a inclus 15 pacienţi dintr-un total de 220 pacienţi cunoscuţi clinicii de Gastroenterologie a Spitalului Clinic de Urgenţă București cu Boală Infla- matorie Intestinală, internaţi în perioada 2013-2016, pentru suprainfecţie cu Clostridium Difficile. Rezultate: Vârsta medie a fost 44,1 ani. Prevalenţa infecţiei cu Clostridium Difficile (ICD) în rândul pacienţilor cu boală inflamatorie intestinală a fost de 6,81%. Suprainfecţia cu Clostridium Difficile a fost mult mai frecventă la pacienţii cu Rectoco- ORIGINAL PAPERS