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Clostridioides difficile toxin is infrequently detected in inflammatory bowel disease and does not associate with clinical outcomes

INTRODUCTION: Clostridioides difficile infection (CDI) rates and outcomes can vary based on differences in testing strategy. Our aim was to assess the prevalence of toxin detection in inflammatory bowel disease (IBD) when compared to those without IBD. Secondly, the clinical outcomes of CDI in IBD w...

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Autores principales: Bernard, Rachel, Hammami, Muhammad B., Arnold, Forest W., Mcgrath, Brian, Patel, Alieysa, Wuerth, Brandon, Nicholson, Maribeth R., Rao, Krishna, Micic, Dejan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9426007/
https://www.ncbi.nlm.nih.gov/pubmed/36042530
http://dx.doi.org/10.1186/s13099-022-00511-2
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author Bernard, Rachel
Hammami, Muhammad B.
Arnold, Forest W.
Mcgrath, Brian
Patel, Alieysa
Wuerth, Brandon
Nicholson, Maribeth R.
Rao, Krishna
Micic, Dejan
author_facet Bernard, Rachel
Hammami, Muhammad B.
Arnold, Forest W.
Mcgrath, Brian
Patel, Alieysa
Wuerth, Brandon
Nicholson, Maribeth R.
Rao, Krishna
Micic, Dejan
author_sort Bernard, Rachel
collection PubMed
description INTRODUCTION: Clostridioides difficile infection (CDI) rates and outcomes can vary based on differences in testing strategy. Our aim was to assess the prevalence of toxin detection in inflammatory bowel disease (IBD) when compared to those without IBD. Secondly, the clinical outcomes of CDI in IBD were assessed using two-step testing strategies. METHODS: We included patients undergoing CDI testing from four academic centers in the United States between January 1, 2018 and June 30, 2020. First the prevalence of toxin detection was compared between individuals with IBD and those without IBD. Secondly, among patients with IBD a primary composite outcome of abdominal colectomy, admission to an intensive care unit (ICU) or death within 30 days of C. difficile testing was assessed across the three categorical groups (screen positive/toxin positive, screen positive/toxin negative and screen negative assay) resulting from the two-step testing strategy. RESULTS: When comparing individuals with a positive screening assay, patients with IBD were less likely to have toxin detected by enzyme immunoassay (EIA) as compared to the non-IBD population (22/145 (15.2%) vs. 413/1144 (36.1%), p < 0.0001). Among all patients with IBD (n = 300), twenty-five (8.3%) had a screen positive assay/toxin positive assay, 136 (45.3%) had a screen positive/toxin negative assay and 139 (46.3%) had a negative screening assay. No significant difference in the primary composite outcome was detected across the three groups (p = 0.566). CONCLUSION: When compared to those without IBD, patients with IBD have a reduced proportion of cases of C. difficile with toxin positivity. Differences in clinical outcomes among patients with IBD were not detected and limited by the infrequent detection of expressed toxin. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13099-022-00511-2.
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spelling pubmed-94260072022-08-31 Clostridioides difficile toxin is infrequently detected in inflammatory bowel disease and does not associate with clinical outcomes Bernard, Rachel Hammami, Muhammad B. Arnold, Forest W. Mcgrath, Brian Patel, Alieysa Wuerth, Brandon Nicholson, Maribeth R. Rao, Krishna Micic, Dejan Gut Pathog Brief Report INTRODUCTION: Clostridioides difficile infection (CDI) rates and outcomes can vary based on differences in testing strategy. Our aim was to assess the prevalence of toxin detection in inflammatory bowel disease (IBD) when compared to those without IBD. Secondly, the clinical outcomes of CDI in IBD were assessed using two-step testing strategies. METHODS: We included patients undergoing CDI testing from four academic centers in the United States between January 1, 2018 and June 30, 2020. First the prevalence of toxin detection was compared between individuals with IBD and those without IBD. Secondly, among patients with IBD a primary composite outcome of abdominal colectomy, admission to an intensive care unit (ICU) or death within 30 days of C. difficile testing was assessed across the three categorical groups (screen positive/toxin positive, screen positive/toxin negative and screen negative assay) resulting from the two-step testing strategy. RESULTS: When comparing individuals with a positive screening assay, patients with IBD were less likely to have toxin detected by enzyme immunoassay (EIA) as compared to the non-IBD population (22/145 (15.2%) vs. 413/1144 (36.1%), p < 0.0001). Among all patients with IBD (n = 300), twenty-five (8.3%) had a screen positive assay/toxin positive assay, 136 (45.3%) had a screen positive/toxin negative assay and 139 (46.3%) had a negative screening assay. No significant difference in the primary composite outcome was detected across the three groups (p = 0.566). CONCLUSION: When compared to those without IBD, patients with IBD have a reduced proportion of cases of C. difficile with toxin positivity. Differences in clinical outcomes among patients with IBD were not detected and limited by the infrequent detection of expressed toxin. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13099-022-00511-2. BioMed Central 2022-08-30 /pmc/articles/PMC9426007/ /pubmed/36042530 http://dx.doi.org/10.1186/s13099-022-00511-2 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Brief Report
Bernard, Rachel
Hammami, Muhammad B.
Arnold, Forest W.
Mcgrath, Brian
Patel, Alieysa
Wuerth, Brandon
Nicholson, Maribeth R.
Rao, Krishna
Micic, Dejan
Clostridioides difficile toxin is infrequently detected in inflammatory bowel disease and does not associate with clinical outcomes
title Clostridioides difficile toxin is infrequently detected in inflammatory bowel disease and does not associate with clinical outcomes
title_full Clostridioides difficile toxin is infrequently detected in inflammatory bowel disease and does not associate with clinical outcomes
title_fullStr Clostridioides difficile toxin is infrequently detected in inflammatory bowel disease and does not associate with clinical outcomes
title_full_unstemmed Clostridioides difficile toxin is infrequently detected in inflammatory bowel disease and does not associate with clinical outcomes
title_short Clostridioides difficile toxin is infrequently detected in inflammatory bowel disease and does not associate with clinical outcomes
title_sort clostridioides difficile toxin is infrequently detected in inflammatory bowel disease and does not associate with clinical outcomes
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9426007/
https://www.ncbi.nlm.nih.gov/pubmed/36042530
http://dx.doi.org/10.1186/s13099-022-00511-2
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