Thread by @john_damianosMD

C. difficile in #IBD, with @DrJessicaA

@AmCollegeGastro #ACG2021

CDI is epidemic level, especially in #IBD

CDI can be disease defining in #IBD

Diagnosis is even trickier in #IBD

Need to know which test your institution offers

Treatment of CDI in #IBD has additional considerations

Metronidazole is inferior in the treatment of hypervirulent strains of C. difficile

@DrJessicaA: "I consider #IBD a marker of severity of C. difficile infection."

Do. Not. Use. Metronidazole!

Need to treat BOTH CDI *and* #IBD flare.

Treatment of rCDI in #IBD

Think #FMT and don't forget bezlotoxumab

Bezlo is for PREVENTION of recurrence, not treatment. Should be given during treatment of CDI.

SIGNIFICANTLY decreases rCDI, especially in #IBD

#FMT is a drug and a biologic

#FMT is well established in rCDI

Specifics of #FMT

#FMT does not have major safety concerns to date, but 2 cases of new onset ulcerative colitis have been reported. Interest into looking at longer term consequences such as autoimmunity, Parkinson disease, etc.

#FMT exceedingly effective for rCDI

What about #FMT for rCDI in #IBD?

Very few rCDI, and vast majority were decolonized

#IBD outcomes also improved with #FMT

CDI treatment in #IBD

Take home points from @DrJessicaA