The vexed relationship between Clostridium difficile and inflammatory bowel disease: an assessment of carriage in an outpatient setting among patients in remission.
Authors
Clayton, Evelyn MRea, 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
2009-05MeSH
AdolescentAdult
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
Metadata
Show full item recordCitation
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 gastroenterologyDOI
10.1038/ajg.2009.4PubMed ID
19319128Abstract
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
ArticleLanguage
enISSN
1572-0241ae974a485f413a2113503eed53cd6c53
10.1038/ajg.2009.4
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