The diagnostic yield of stool pathogen studies during relapses of inflammatory bowel disease.
OBJECTIVE
We sought to determine the yield of stool analysis for bacterial culture, ova and parasites, and Clostridium difficile toxin in suspected relapses of inflammatory bowel disease (IBD).


BACKGROUND
The diagnostic yield of such stool studies has not been examined recently in the United States.


METHODS
The medical records of consecutive IBD patients who underwent stool testing for relapses at our institution between July 1, 2000, and November 25, 2001, were abstracted for demographics, stool test results, recent antibiotic exposure, and hospitalization.


RESULTS
Fifty-four patients were evaluated during 62 relapses with 99 stool samples. Twelve stool tests were positive. C. difficile accounted for the majority of positive tests (10/12). Of these, 9 (90%) were associated with antibiotic use in the prior month versus 10 (22%) in the C. difficile-negative group (P < 0.001). Hospitalization, prednisone use, or sulfasalazine use did not differ significantly with C. difficile status. Eight C. difficile-positive patients improved clinically with targeted antibiotic therapy. Two bacterial cultures (4%) were positive for Campylobacter jejuni and Plesiomonas shigelloides.


CONCLUSIONS
Stool studies yielded a pathogen, mainly C. difficile, in 20% of the relapsing IBD patients. Antibiotic use was significantly associated with a positive C. difficile toxin. Toxin-positive patients improved clinically with targeted antibiotics.
Meyer
Angela M
AM
Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona 85259, USA.
Ramzan
Nizar N
NN
Loftus
Edward V
EV
Heigh
Russell I
RI
Leighton
Jonathan A
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D016123:Campylobacter jejuni / Q000302:isolation & purification; D016360:Clostridioides difficile / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D016981:Plesiomonas / Q000302:isolation & purification; D011239:Prednisolone / Q000627:therapeutic use; D012008:Recurrence; D012460:Sulfasalazine / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D012460:Sulfasalazine; D011239:Prednisolone