Risk Factor Analysis and Prevalence of Infectious Agents in Inflammatory Bowel Disease Flares: A Retrospective Study

Background: Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is a chronic relapsing-remitting disorder with a rising global incidence. Infectious agents, particularly Clostridium difficile, are frequently considered during IBD flares. However, the role of other infectious agents during these exacerbations remains unclear. Objectives: The objective of the current study was to assess the prevalence of infectious agents, including C. difficile, in stool samples of patients with IBD flares and to assess potential risk factors. Methods: A retrospective review was conducted on medical records of IBD patients admitted for flare-ups at Mount Sinai Hospital, Toronto, from October 2018 to August 2019. Stool testing, including cultures, ova, parasites, and C. difficile, was analyzed. Demographic and clinical data were collected, and chi-square tests were used for statistical analysis. Results: A total of 96 patients (51 CD, 43 UC, 2 IBD-U) were included. Nine patients (9%) tested positive for C. difficile. No other bacterial or parasitic infections were detected. Testing for Cytomegalovirus was performed in 33 patients, with no positive cases. Risk factors, including IBD phenotype, biologic or steroid therapy, and prior antibiotic use, showed no significant association with C. difficile infection. Conclusions: Clostridium difficile was the predominant infectious agent in IBD flares, while other bacterial and parasitic infections were rare. Routine stool testing, particularly for non-C. difficile pathogens, has a low diagnostic yield in this population. Further studies with larger, generalized cohorts are needed to explore these associations and identify risk factors for infectious colitis in IBD patients.