title: Clostridium difficile infection in acute flares of inflammatory bowel disease: A prospective study.
abstract: OBJECTIVE
  Clostridium difficile infection (CDI) is a common complication in inflammatory bowel disease (IBD) and has been associated with poor IBD outcome. The aims of our study were to look for predictive factors of CDI in patients hospitalized for IBD flare and to evaluate a rapid testing strategy in this population.
  
  
  METHODS
  Consecutive patients hospitalized for IBD flare in Saint-Antoine Hospital (Paris, France) were prospectively tested for CDI with a defined strategy involving rapid testing and reference methods. Risk factors for CDI were investigated and performances of diagnostic tests were evaluated.
  
  
  RESULTS
  C. difficile testing was performed at admission in 461 hospitalizations for IBD flare. CDI was diagnosed in 35 cases (7.6%) and non-toxigenic C. difficile was identified in 10 cases (2.2%). In multivariate analysis, UC phenotype was associated with CDI (OR 2.2, 95% CI 1.03-4.6, p=0.047). Glutamate dehydrogenase (GDH) test had a 97.1% sensitivity and a 100% negative predictive value for CDI diagnosis but a positive predictive value of 79.1%. Enzyme immunoassay (EIA)-based toxin detection (C. Diff Quik Chek complete®, Alere) had a poor sensitivity and diagnosis was rescued by toxin PCR in 100% of cases.
  
  
  CONCLUSIONS
  CDI is frequent in patients hospitalized for IBD flare. Clinical parameters do not help for the diagnosis and rapid testing should be performed in all patients. Currently, a negative result of an EIA-based toxin search associated with a positive GDH test cannot rule out a CDI and should not delay initiation of specific treatment in case of severe symptoms or high presumption.
authors.affiliation: Department of Gastroenterology, Saint Antoine Hospital, AP-HP, and GRC-UPMC 03, UPMC University Paris 06, Paris, France; Sorbonne University-UPMC Univ Paris 06, INSERM ERL 1157, Avenir Team Gut Microbiota and Immunity, UMR 7203, Saint-Antoine Hospital, Paris, France; INRA, UMR1319 Micalis & AgroParisTech, Jouy en Josas, France; Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France. Electronic address: harry.sokol@aphp.fr.
authors.forename: Harry
authors.initials: H
authors.lastname: Sokol
authors.affiliation: Department of Microbiology, Saint Antoine Hospital, AP-HP, UPMC University Paris 06, Paris, France; Clinical Research Group EPIDIFF, UPMC University Paris 03, Paris, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Lalande
authors.affiliation: Department of Gastroenterology, Saint Antoine Hospital, AP-HP, and GRC-UPMC 03, UPMC University Paris 06, Paris, France.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Landman
authors.affiliation: Department of Gastroenterology, Saint Antoine Hospital, AP-HP, and GRC-UPMC 03, UPMC University Paris 06, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Bourrier
authors.affiliation: Department of Gastroenterology, Saint Antoine Hospital, AP-HP, and GRC-UPMC 03, UPMC University Paris 06, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Nion-Larmurier
authors.affiliation: Department of Gastroenterology, Saint Antoine Hospital, AP-HP, and GRC-UPMC 03, UPMC University Paris 06, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Rajca
authors.affiliation: Department of Gastroenterology, Saint Antoine Hospital, AP-HP, and GRC-UPMC 03, UPMC University Paris 06, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Kirchgesner
authors.affiliation: Department of Gastroenterology, Saint Antoine Hospital, AP-HP, and GRC-UPMC 03, UPMC University Paris 06, Paris, France; Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Seksik
authors.affiliation: Department of Gastroenterology, Saint Antoine Hospital, AP-HP, and GRC-UPMC 03, UPMC University Paris 06, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Cosnes
authors.affiliation: Department of Microbiology, Saint Antoine Hospital, AP-HP, UPMC University Paris 06, Paris, France; National Reference Laboratory for Clostridium difficile, Saint Antoine Hospital, AP-HP, UPMC University Paris 06, Paris, France; Clinical Research Group EPIDIFF, UPMC University Paris 03, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Barbut
authors.affiliation: Department of Gastroenterology, Saint Antoine Hospital, AP-HP, and GRC-UPMC 03, UPMC University Paris 06, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Beaugerie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis*; D016208:Databases, Factual; D003955:Diagnostic Tests, Routine; D005243:Feces / Q000382:microbiology; D005260:Female; D005602:France; D006801:Humans; D007124:Immunoenzyme Techniques; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000382:microbiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D055815:Young Adult
keywords: Clostridium difficile; Crohn; Ulcerative colitis