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Diagnostic Modality of Clostridioides difficile Infection Predicts Treatment Response and Outcomes in Inflammatory Bowel Disease

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Abstract

Background

Inflammatory bowel disease (IBD) patients are at increased risk of developing Clostridioides difficile infection (CDI). Common methods to diagnose CDI involve a combination of tests including the toxin A/B enzyme immunoassay (Toxin) and toxin gene polymerase chain reaction assay (PCR). Disease outcomes in Toxin+ versus Toxin-PCR+ IBD patients remain unclear.

Aims

This study aimed to examine the response to antibiotics and risk of IBD therapy escalation in Toxin+ versus Toxin-PCR+ patients.

Methods

IBD patients at an academic center with CDI diagnosis based on Toxin+ or Toxin-PCR+ from 2012 to 2017 were identified. Comparisons of response to antibiotics within 30 days and escalation of IBD therapy within 90 days of CDI diagnosis between these two groups were analyzed by Chi-square analysis. Multivariable regression analysis examined factors associated with antibiotic response.

Results

Among 92 patients included, 61% had Crohn’s disease and 39% had ulcerative colitis. 70% tested Toxin-PCR+. 60% received vancomycin or fidaxomicin to treat CDI. 82% of Toxin+ patients responded to antibiotics compared to 25% of Toxin-PCR+ patients (p < 0.001). 21% of Toxin+ patients required IBD therapy escalation compared to 63% of Toxin-PCR+ patients (p < 0.001). When adjusted for the types of antibiotics used, IBD subtypes, and immunosuppression status, positivity to Toxin (OR 14.85, CI 4.62–47.72) was the most significant predictor of response to antibiotics.

Conclusions

Toxin+ compared to Toxin-PCR+ IBD patients had a significantly higher rate of response to antibiotics and lower chances of requiring IBD therapy escalation. Future outcome studies involving CDI in IBD patients should be stratified by modality of diagnosis.

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This study was not funded.

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Correspondence to Vu Q. Nguyen.

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Conflict of interest

Vu Q. Nguyen has received grant support from AbbVie Inc and American College of Gastroenterology. Dario Sorrentino has received consulting fees from Abbott/AbbVie, Centocor Inc., Ferring, Hoffman-LaRoche, Giuliani, Schering-Plough, MSD, Janssen Research & Development, and TechLab and research grants from AbbVie, Centocor, Crohn’s and Colitis Foundations, Janssen Research & Development, LLC, Medtronics, Schering-Plough, Takeda, TechLab, and serves in the Speakers Bureau of AbbVie and the National Faculty of Janssen.

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Gupta, A., Wash, C., Wu, Y. et al. Diagnostic Modality of Clostridioides difficile Infection Predicts Treatment Response and Outcomes in Inflammatory Bowel Disease. Dig Dis Sci 66, 547–553 (2021). https://doi.org/10.1007/s10620-020-06205-6

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  • DOI: https://doi.org/10.1007/s10620-020-06205-6

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