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Faecal lactoferrin and calprotectin in patients with Clostridium difficile infection: a case–control study

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Abstract

Calprotectin and lactoferrin are released by the gastrointestinal tract in response to infection and mucosal inflammation. Our objective was to assess the usefulness of quantifying faecal lactoferrin and calprotectin concentrations in Clostridium difficile infection (CDI) patients with or without free toxins in the stools. We conducted a single-centre 22-month case–control study. Patients with a positive CDI diagnosis were compared to two control groups: group 1 = diarrhoeic patients negative for C. difficile and matched (1:1) to CDI cases on the ward location and age, and group 2 = diarrhoeic patients colonised with a non-toxigenic strain of C. difficile. Faecal lactoferrin and calprotectin concentrations in faeces were determined for patients with CDI and controls. Of 135 patients with CDI, 87 (64.4%) had a positive stool cytotoxicity assay (free toxin) and 48 (35.6%) had a positive toxigenic culture without detectable toxins in the stools. The median lactoferrin values were 26.8 μg/g, 8.0 μg/g and 15.8 μg/g in CDI patients and groups 1 and 2, respectively. The median calprotectin values were 218.0 μg/g, 111.5 μg/g and 111.3 μg/g, respectively. Among patients with CDI, faecal lactoferrin and calprotectin levels were higher in those with free toxins in their stools (39.2 vs. 10.2 μg/g, p = 0.003 and 274.0 vs. 166.0 μg/g, p = 0.051, respectively). Both faecal calprotectin and lactoferrin were higher in patients with CDI, especially in those with detectable toxin in faeces, suggesting a correlation between intestinal inflammation and toxins in stools.

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Authors and Affiliations

  1. National Reference Laboratory for Clostridium difficile, Hôpital Saint Antoine, AP-HP, 75012, Paris, France

    F. Barbut, L. Suzon, R. Syed-Zaidi & C. Eckert

  2. UPMC Univ Paris 06, GRC n°2, Epidiff, Paris, France

    F. Barbut, L. Suzon, R. Syed-Zaidi, V. Lalande & C. Eckert

  3. Unité d’Hygiène et de Lutte contre les Infections Nosocomiales, Hôpital Saint-Antoine, AP-HP, Paris, France

    F. Barbut & C. Gouot

  4. Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP UMRS 1136), 75012, Paris, France

    N. Lapidus

  5. Département de Santé Publique, Hôpital Saint-Antoine, AP-HP, 75012, Paris, France

    N. Lapidus

  6. Département de Bactériologie, Hôpital Saint-Antoine, AP-HP, Paris, France

    V. Lalande

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  1. F. Barbut
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  2. C. Gouot
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  7. C. Eckert
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Correspondence to F. Barbut.

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Funding/support

The study was sponsored by the Association Robert Debré pour la Recherche Médicale. Astellas provided a research grant to the Association Robert Debré pour la Recherche Médicale based on the study protocol.

Astellas had no role in the study design and conduct, and was not involved in the data collection, data management, or data analysis and interpretation. Astellas provided editorial assistance with grammar and English language editing.

Conflict of interest

Frédéric Barbut reports grants, personal fees and non-financial support from Astellas, personal fees from Pfizer, grants and personal fees from Sanofi Pasteur, grants and non-financial support from Anios, grants, personal fees and non-financial support from MSD, grants from bioMérieux, grants from Quidel Bühlmann, grants from Diasorin, grants from Cubist, grants from Biosynex and grants from GenePoc; Catherine Eckert reports non-financial support from Astellas and Mobidiag.

Ethical approval

The study protocol was approved by the local Research Ethics Committee and presented to the Infection Control Committee.

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Barbut, F., Gouot, C., Lapidus, N. et al. Faecal lactoferrin and calprotectin in patients with Clostridium difficile infection: a case–control study. Eur J Clin Microbiol Infect Dis 36, 2423–2430 (2017). https://doi.org/10.1007/s10096-017-3080-y

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  • DOI: https://doi.org/10.1007/s10096-017-3080-y

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