Outcomes in patients with inflammatory bowel disease and acute gastrointestinal symptoms who test indeterminate for Clostridioides difficile. Ann Gastroenterol 2022;35(2):135-139
Date
04/29/2022Pubmed ID
35479586Pubmed Central ID
PMC8922265DOI
10.20524/aog.2022.0690Scopus ID
2-s2.0-85129263357 (requires institutional sign-in at Scopus site) 1 CitationAbstract
BACKGROUND: Inflammatory bowel disease (IBD) and Clostridioides difficile infection (CDI) can present with similar symptoms. The current preferred method for diagnosing CDI is the nucleic acid amplification test (NAAT) for C. difficile in stool, followed by reflex toxin enzyme immunoassay (EIA) when NAAT is positive. The clinical significance of NAAT(+)/EIA(-) in the IBD population is uncertain.
METHODS: This retrospective cohort included IBD patients who presented with acute onset of gastrointestinal symptoms and a C. difficile NAAT(+) test. The primary outcome was C. difficile recurrence within 12 months. Other outcomes examined included hospital admissions within 30 days of CDI, change of IBD maintenance therapy within 90 days of CDI, and complications such as bowel resection or death.
RESULTS: A total of 71 patients were included. Eighty-four percent of the tests were EIA(-) and among the EIA(-) 88% were treated with antibiotics. Outcomes between EIA(+) and EIA(-) were not significantly different in terms of recurrences, admissions, changes to IBD medications or complications. Outcomes were also similar when comparing those who received antibiotic therapy to those who did not.
CONCLUSIONS: Our cohort did not demonstrate a significant difference in outcomes between EIA(+) and EIA(-) C. difficile patients. Treatment for EIA(-) patients did not improve outcomes. Even though there may be a role for antibiotic therapy in IBD patients who test NAAT(+)/EIA(-) for C. difficile, further studies will be needed to identify that subpopulation.
Author List
Johnson LK, Munoz-Price S, Patel PB, Patel A, Stein DJ, Yarur AJAuthors
Poonam Beniwal-Patel MD Associate Professor in the Medicine department at Medical College of WisconsinDaniel J. Stein MD Director, Associate Professor in the Medicine department at Medical College of Wisconsin
