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    The vexed relationship between Clostridium difficile and inflammatory bowel disease: an assessment of carriage in an outpatient setting among patients in remission.

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    Authors
    Clayton, Evelyn M
    Rea, Mary C
    Shanahan, Fergus
    Quigley, Eamonn M M
    Kiely, Barry
    Hill, Colin
    Ross, R Paul
    Affiliation
    Alimentary Pharmabiotic Centre at Moorepark Food Research Centre, Teagasc, Fermoy Co., Cork, Ireland.
    Issue Date
    2009-05
    MeSH
    Adolescent
    Adult
    Age Distribution
    Ambulatory Care
    Bacterial Toxins
    Carrier State
    Case-Control Studies
    Clostridium Infections
    Clostridium difficile
    Colitis, Ulcerative
    Comorbidity
    Crohn Disease
    Female
    Follow-Up Studies
    Humans
    Incidence
    Inflammatory Bowel Diseases
    Male
    Microbial Sensitivity Tests
    Middle Aged
    Probability
    Reference Values
    Remission, Spontaneous
    Severity of Illness Index
    Sex Distribution
    Young Adult
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    Citation
    The vexed relationship between Clostridium difficile and inflammatory bowel disease: an assessment of carriage in an outpatient setting among patients in remission. 2009, 104 (5):1162-9 Am. J. Gastroenterol.
    Journal
    The American journal of gastroenterology
    URI
    http://hdl.handle.net/10147/201210
    DOI
    10.1038/ajg.2009.4
    PubMed ID
    19319128
    Abstract
    Comorbidity with Clostridium difficile may cause diagnostic delay in newly presenting inflammatory bowel disease (IBD) patients, trigger relapse in established disease, confound therapies, and serve as an indicator of an underlying defect in innate immunity. Retrospective analyses have suggested community acquisition; to address this we conducted a prospective analysis of C. difficile carriage in IBD patients using molecular methods specifically in an outpatient setting.
    Recruited participants had long-standing diagnoses of ulcerative colitis (n = 64) and Crohn's disease (n = 58), were in clinical remission, and had no recent exposure to antibiotics, corticosteroids, immunomodulatory drugs or recent hospitalization. Isolates were cultured from stools and confirmed by 16S sequencing. The antibiotic susceptibilities of the isolates were tested followed by further strain characterization by toxinotyping, ribotyping, and pulsed-field gel electrophoresis (PFGE).
    The frequency of toxigenic C. difficile was higher in IBD patients than in healthy volunteers at 8.2 and 1.0%, respectively (P = 0.02 Fisher's exact test). All strains belonged to toxinotype 0 with rare subtypes of this group noted in five isolates and represented by an altered repressor genotype. Patients harbored a diverse range of toxigenic ribotype groups, including those previously associated with C. difficile-associated disease (CDAD) (R015, R005, and R020) and the rarer types R062, R050, and R003. Interestingly, common nosocomial groups were not identified. The considerable nonclonal distribution of distinct strains was further demonstrated by PFGE genomic fingerprinting. None of the study subjects experienced a clinical episode of CDAD during a 6-month period of follow-up.
    Detection of C. difficile is increased in IBD outpatients in remission, and strain diversity is consistent with community acquisition from a multitude of sources.
    Item Type
    Article
    Language
    en
    ISSN
    1572-0241
    ae974a485f413a2113503eed53cd6c53
    10.1038/ajg.2009.4
    Scopus Count
    Collections
    Cork University Hospital

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