Direct fecal detection of<i>Clostridium difficile</i> in patients with recurrent inflammatory bowel disease _West China Medical Journal

Authors：

YANG Jingyu ^1,2 ,  WANG Xiaohui ^1,3 , HUANG liang ^1,4 , YU Rujia ^1,3 , ZONG Zhiyong ^1,3,5

1. Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Geriatric Infection ward, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, P. R. China;
3. Division of Infectious Diseases, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
4. The Third Department of Infectious Diseases, Public Health Clinical Center of Chengdu, Chengdu, Sichuan 610066, P. R. China;
5. Nosocomial Infection Management Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WANG Xiaohui, Email: wang_xiaohui@scu.edu.cn

Keywords：

Inflammatory bowel disease; Clostridium difficile; Rapid laboratory detection

DOI：

10.7507/1002-0179.201701036

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Objective To explore the application of two methods of direct fecal detection ofClostridium difficilein patients with recurrent inflammatory bowel disease (IBD), including nucleic acid amplification test (NAAT) and enzyme immunoassay (EIA), in order to provide support for hospitals to prevent and control clostridium difficile infection (CDI). Methods Fresh feces of 48 patients with recurrent IBD treated between November 2014 and April 2015 were collected within 48 hours after admission. Anaerobic culture and identification, NAAT and EIA were used to test the same samples. Statistical analysis was performed using Kappa test. Results Among the 48 fecal samples,Clostridium difficilewas negative in 37 and positive in 11 including 2 (4.2%) with toxigenicClostridium difficile characterized as toxin type A⁺B⁺. Compared with anaerobic culture and identification, NAAT had a perfect correlation (Kappa=1.00,P<0.05), and EIA had an almost perfect correlation (Kappa=0.89,P<0.05). But EIA toxin test had missed detection of toxigenic samples. Conclusions For patients with recurrent IBD combined with CDI, both NAAT and EIA test may be applied to detctClostridium difficile in feces directly, while NAAT may show a better performance. Samples from highly suspected patients with negative toxin result tested by EIA should be confirmed by other methods such as NAAT.

Citation： YANG Jingyu, WANG Xiaohui, HUANG liang, YU Rujia, ZONG Zhiyong. Direct fecal detection ofClostridium difficile in patients with recurrent inflammatory bowel disease . West China Medical Journal, 2017, 32(3): 324-328. doi: 10.7507/1002-0179.201701036 Copy

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6.	Lemee L, Dhalluin A, Testelin S,et al. Multiplex PCR targetingtpi (triose phosphate isomerase),tcdA (Toxin A), andtcdB (Toxin B) genes for toxigenic culture ofClostridium difficile. J Clin Microbiol, 2004, 42(12): 5710-5714.
7.	Persson S, Torpdahl M, Olsen KE. New multiplex PCR method for the detection ofClostridium difficile toxin A (tcdA) and toxin B (tcdB) and the binary toxin (cdtA/cdtB) genes applied to a Danish strain collection. Clin Microbiol Infect, 2008, 14(11): 1057-1064.
8.	Freeman J, Bauer P, Baines D,et al. The changing epidemiology ofClostridium difficile infections. Clin Microbiol Rev, 2010, 23(3): 529-549.
9.	郭爽. 美疾控中心首次对耐药细菌分级. 吉林医学信息, 2014(1): 24.
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11.	Clayton M, Rea C, Shanahan F,et al. The vexed relationship betweenClostridium difficile and inflammatory bowel disease: an assessment of carriage in an outpatient setting among patients in remission. Am J Gastroenterol, 2009, 104(5): 1162-1169.
12.	Jin K, Wang S, Huang Z,et al.Clostridium difficile infections in China. J Biomed Res, 2010, 24(6): 411-416.
13.	Wang X, Cai L, Yu R,et al. ICU-OnsetClostridium difficile infection in a university hospital in China: a prospective cohort study. PLoS One, 2014, 9(11): e111735.
14.	Zhang X, Wang X, Yang J,et al. Colonization of toxigenicClostridium difficile among ICU patients: a prospective study. BMC Infect Dis, 2016(16): 397.
15.	徐亚青, 邓敏. 难辨梭状芽孢杆菌医院感染的流行病学特征及感染控制现状分析. 中华医院感染学杂志, 2013, 23(20): 5073-5075.
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1. Kelly CP, Lamont JT.Clostridium difficile - more difficult than ever. N Engl J Med, 2008, 359(18): 1932-1940.
2. Issa M, Ananthakrishnan AN, Binion DG.Clostridium difficile and inflammatory bowel disease. Inflamm Bowel Dis, 2008, 14(10): 1432-1442.
3. Ananthakrishnan AN, Mcginley EL, Saeian KA. Temporal trends in disease outcomes related toClostridium difficile infection in patients with inflammatory bowel disease. Inflamm Bowel Dis, 2011, 17(4): 976-983.
4. Surawicz CM, Brandt LJ, Binion DG,et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol, 2013, 108(4): 478-498.
5. Peterson R, Mehta S, Patel A,et al. Laboratory testing forClostridium difficile infection: light at the end of the tunnel. Am J Clin Pathol, 2011, 136(3): 372-380.
6. Lemee L, Dhalluin A, Testelin S,et al. Multiplex PCR targetingtpi (triose phosphate isomerase),tcdA (Toxin A), andtcdB (Toxin B) genes for toxigenic culture ofClostridium difficile. J Clin Microbiol, 2004, 42(12): 5710-5714.
7. Persson S, Torpdahl M, Olsen KE. New multiplex PCR method for the detection ofClostridium difficile toxin A (tcdA) and toxin B (tcdB) and the binary toxin (cdtA/cdtB) genes applied to a Danish strain collection. Clin Microbiol Infect, 2008, 14(11): 1057-1064.
8. Freeman J, Bauer P, Baines D,et al. The changing epidemiology ofClostridium difficile infections. Clin Microbiol Rev, 2010, 23(3): 529-549.
9. 郭爽. 美疾控中心首次对耐药细菌分级. 吉林医学信息, 2014(1): 24.
10. Rodemann JF, Dubberke ER, Reske KA,et al. Incidence ofClostridium difficile infection in inflammatory bowel disease. Clin Gastroenterol Hepatol, 2007, 5(3): 339-344.
11. Clayton M, Rea C, Shanahan F,et al. The vexed relationship betweenClostridium difficile and inflammatory bowel disease: an assessment of carriage in an outpatient setting among patients in remission. Am J Gastroenterol, 2009, 104(5): 1162-1169.
12. Jin K, Wang S, Huang Z,et al.Clostridium difficile infections in China. J Biomed Res, 2010, 24(6): 411-416.
13. Wang X, Cai L, Yu R,et al. ICU-OnsetClostridium difficile infection in a university hospital in China: a prospective cohort study. PLoS One, 2014, 9(11): e111735.
14. Zhang X, Wang X, Yang J,et al. Colonization of toxigenicClostridium difficile among ICU patients: a prospective study. BMC Infect Dis, 2016(16): 397.
15. 徐亚青, 邓敏. 难辨梭状芽孢杆菌医院感染的流行病学特征及感染控制现状分析. 中华医院感染学杂志, 2013, 23(20): 5073-5075.
16. Martin J, Wilcox M. New and emerging therapies forClostridium difficile infection. Curr Opin Infect Dis, 2016, 29(6): 546-554.

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