Division of Pediatric Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MA 02115, USA.
J Pediatr Gastroenterol Nutr. 2013 Sep;57(3):293-7. doi: 10.1097/MPG.0b013e3182999990.
Clinicians often evaluate for Clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD) presenting with exacerbations. A highly sensitive polymerase chain reaction (PCR) test for the toxin B gene of C difficile is increasingly used to diagnose CDI. The aim of this study was to determine the prevalence of positive C difficile PCR results in children and young adults with and without active IBD compared with patients with non-IBD gastrointestinal disease.
Fecal samples were obtained from patients with ulcerative colitis (UC, n = 76) or Crohn disease (CD, n = 69) and 51 controls followed in our gastroenterology program. Samples were analyzed for C difficile using a PCR test for the C difficile toxin B gene (BD GeneOhm Cdiff assay). Proportions of positive tests in each group were compared using the Pearson χ2 test.
The prevalence of positive PCR results was 11.6% in patients with CD, 18.4% in patients with UC, and 11.8% in controls (P = 0.25). There were no significant differences in the prevalence of positive C difficile results among patients with IBD with and without active disease or among patients with and without diarrhea.
Positive C difficile PCR results occur with similar frequency in patients with IBD with and without active disease and in patients with other gastrointestinal diseases. A positive result in a highly sensitive PCR assay that detects low copy numbers of a toxin gene in C difficile may reflect colonization in a subset of patients with IBD, confounding clinical decision making in managing disease exacerbations.
在出现炎症性肠病（IBD）加重的患者中，临床医生经常评估艰难梭菌感染（CDI）。一种用于检测艰难梭菌毒素 B 基因的高灵敏度聚合酶链反应（PCR）检测越来越多地用于诊断 CDI。本研究旨在确定与非 IBD 胃肠道疾病患者相比，有和无活动 IBD 的儿童和年轻成人中阳性艰难梭菌 PCR 结果的流行率。
从我们的胃肠病学计划中随访的溃疡性结肠炎（UC，n = 76）或克罗恩病（CD，n = 69）患者和 51 名对照中获得粪便样本。使用艰难梭菌毒素 B 基因的 PCR 检测（BD GeneOhm Cdiff 检测）分析样本是否存在艰难梭菌。使用 Pearson χ2 检验比较每组中阳性检测的比例。
CD 患者中阳性 PCR 结果的流行率为 11.6%，UC 患者为 18.4%，对照组为 11.8%（P = 0.25）。有和无活动疾病的 IBD 患者以及有和无腹泻的患者中，艰难梭菌阳性结果的流行率没有显着差异。
在有和无活动疾病的 IBD 患者以及其他胃肠道疾病患者中，艰难梭菌阳性 PCR 结果的发生率相似。在艰难梭菌中检测低拷贝数毒素基因的高灵敏度 PCR 检测中出现阳性结果可能反映了一部分 IBD 患者的定植，从而混淆了管理疾病加重的临床决策。
