Sokol Harry, Lalande Valérie, Landman Cecilia, Bourrier Anne, Nion-Larmurier Isabelle, Rajca Sylvie, Kirchgesner Julien, Seksik Philippe, Cosnes Jacques, Barbut Frédéric, Beaugerie Laurent
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.
Department of Microbiology, Saint Antoine Hospital, AP-HP, UPMC University Paris 06, Paris, France; Clinical Research Group EPIDIFF, UPMC University Paris 03, Paris, France.
Dig Liver Dis. 2017 Jun;49(6):643-646. doi: 10.1016/j.dld.2017.01.162. Epub 2017 Jan 30.
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.
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.
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.
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.
艰难梭菌感染（CDI）是炎症性肠病（IBD）的常见并发症，且与IBD不良预后相关。我们研究的目的是寻找因IBD发作住院患者发生CDI的预测因素，并评估该人群中的快速检测策略。
对在圣安托万医院（法国巴黎）因IBD发作住院的连续患者，采用包括快速检测和参考方法的既定策略对CDI进行前瞻性检测。调查CDI的危险因素，并评估诊断试验的性能。
在461例因IBD发作住院的病例中，入院时进行了艰难梭菌检测。35例（7.6%）诊断为CDI，10例（2.2%）鉴定为非产毒艰难梭菌。多因素分析显示，UC表型与CDI相关（比值比2.2，95%可信区间1.03 - 4.6，p = 0.047）。谷氨酸脱氢酶（GDH）检测对CDI诊断的敏感性为97.1%，阴性预测值为100%，但阳性预测值为79.1%。基于酶免疫测定（EIA）的毒素检测（C. Diff Quik Chek complete，Alere）敏感性较差，100%的病例通过毒素PCR得以确诊。
因IBD发作住院的患者中CDI很常见。临床参数对诊断无帮助，所有患者均应进行快速检测。目前，基于EIA的毒素检测结果为阴性且GDH检测结果为阳性不能排除CDI，在出现严重症状或高度怀疑时不应延迟特异性治疗的启动。
