Park Junseok, Kim Seulji, Im Jong Pil, Lee Hyun Jung, Kim Joo Sung, Park Hyunsun, Han Yoo Min, Koh Seong-Joon
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Korea Institute of Radiological and Medical Sciences, Korea Cancer Center Hospital, Seoul, Korea.
Dig Dis Sci. 2025 Apr 21. doi: 10.1007/s10620-025-09045-4.
Clostridioides difficile infection (CDI) frequently occurs concurrently in patients with inflammatory bowel disease (IBD), and differential diagnosis from IBD flares is critical. However, clinical management of C. difficile in IBD patients with polymerase chain reaction toxin-positive (tPCR+)/enzyme immunoassay toxin-negative (tEIA-) results has not yet been investigated.
We aimed to assess the clinical significance of C. difficile tPCR+/tEIA- in patients with IBD and the impact of antibiotic treatment on IBD outcomes.
This single-center, retrospective cohort study included patients with IBD with CDI test results between January 01, 2018, and August 01, 2022. First, the clinical outcomes of IBD, such as medication escalation, hospitalization, and surgery, were compared between patients with IBD with tPCR-/tEIA- and those with tPCR+/tEIA- using Cox regression and propensity score matching. Next, the clinical outcomes of IBD were assessed based on whether antibiotic treatment for CDI was administered to both groups.
Among 412 patients with IBD with PCR test, 71 (17.2%) showed tPCR+/tEIA- results. The tPCR+/tEIA- group showed no statistically significant difference in IBD outcomes compared to the tPCR-/tEIA- group. The antibiotic-treated tPCR+/tEIA- group showed a higher risk of drug escalation and admission than the tPCR-/tEIA- group, while the antibiotic-untreated tPCR+/tEIA- group did not. After drug escalation during the follow-up, the treated tPCR+/tEIA- group showed IBD outcomes similar to those of the tPCR-/tEIA- group.
In patients with IBD with indeterminate CDI, the need for antibiotics should be thoroughly assessed and proper management of underlying IBD such as drug escalation may lead to favorable outcomes.
艰难梭菌感染（CDI）在炎症性肠病（IBD）患者中经常同时发生，与IBD发作的鉴别诊断至关重要。然而，对于聚合酶链反应毒素阳性（tPCR+）/酶免疫测定毒素阴性（tEIA-）结果的IBD患者中艰难梭菌的临床管理尚未进行研究。
我们旨在评估IBD患者中艰难梭菌tPCR+/tEIA-的临床意义以及抗生素治疗对IBD结局的影响。
这项单中心回顾性队列研究纳入了2018年1月1日至2022年8月1日期间有CDI检测结果的IBD患者。首先，使用Cox回归和倾向评分匹配比较IBD患者中tPCR-/tEIA-和tPCR+/tEIA-患者的IBD临床结局，如药物升级、住院和手术情况。接下来，根据两组是否接受CDI抗生素治疗评估IBD的临床结局。
在412例接受PCR检测的IBD患者中，71例（17.2%）显示tPCR+/tEIA-结果。与tPCR-/tEIA-组相比，tPCR+/tEIA-组在IBD结局方面无统计学显著差异。抗生素治疗的tPCR+/tEIA-组比tPCR-/tEIA-组有更高的药物升级和入院风险，但未接受抗生素治疗的tPCR+/tEIA-组则没有。在随访期间药物升级后，接受治疗的tPCR+/tEIA-组显示出与tPCR-/tEIA-组相似的IBD结局。
在CDI不确定的IBD患者中，应全面评估抗生素的必要性，对潜在IBD进行适当管理，如药物升级，可能会带来良好结局。
