Diagnostic Modality of Clostridioides difficile Infection Predicts Treatment Response and Outcomes in Inflammatory Bowel Disease

Gupta, Aanchal; Wash, Christopher; Wu, YingXing; Sorrentino, Dario; Nguyen, Vu Q.

doi:10.1007/s10620-020-06205-6

Cited by 11 publications

(11 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Compared to those without IMDC, patients with concurrent CDI and IMDC had more preceding systemic steroid use, a longer duration of diarrhea and colitis symptoms, and higher grades of diarrhea. On one hand, CDI contributes to inflammation by recruiting additional T-cells, leading to the development of autoimmunity to colonic mucosa and disruption of the gut microbiome [ 19 , 20 ]. On the other hand, more severe IMDC itself could result in greater susceptibility to CDI.…”

Section: Discussionmentioning

confidence: 99%

“…After being treated with antibiotics initially for CDI, patients generally receive escalating immunosuppressive therapy. In one recent study, PCR+/EIA- IBD patients had a poor response to antibiotics, and a majority of these patients required escalation of IBD therapy, thus suggesting that many of these patients were colonized rather than having true CDI [ 20 ]. However, complication rates in PCR+ and EIA+ patients were similar.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clostridioides difficile infection in cancer patients receiving immune checkpoint inhibitors

Vasavada

Panneerselvam

Amin

et al. 2022

aog

View full text Add to dashboard Cite

Background Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, but are associated with immune-mediated diarrhea and colitis (IMDC). Clostridioides difficile infection (CDI) can cause infectious diarrhea with overlapping symptoms. Thus, we sought to elucidate the characteristics of CDI in patients treated with ICI, in the context of IMDC. Methods We conducted a retrospective, single-center study of adult cancer patients (N=421) with ICI exposure from 2015-2020 and a positive stool nucleic acid amplification test and/or enzyme immunoassay for CDI. Baseline characteristics, treatments, and outcomes were compared between patients with and without concurrent IMDC. Results Forty-one eligible patients were included, 27 with concurrent IMDC and 14 without. Twenty-seven patients were taking programmed death-1 or its ligand inhibitors and 14 were taking cytotoxic T-lymphocyte-associated antigen 4 inhibitors. Patients with concurrent CDI and IMDC had a longer symptom duration (20 vs. 5 days, P=0.003) and a higher rate of grade 3-4 diarrhea (41% vs. 7%, P=0.033). Among patients with concurrent IMDC, preceding antibiotics (P=0.050) and proton pump inhibitors (PPI) (P=0.038) were used more frequently among individuals who developed CDI after immunosuppressant exposure. Thirty-eight patients received antibiotics for CDI, while 5 required fecal microbiota transplantation for concurrent CDI & IMDC. Conclusions CDI is common in ICI-treated cancer patients, especially those with IMDC requiring immunosuppressants. Antibiotics did not alter the need for immunosuppressants in those with concurrent IMDC. Use of PPI and antibiotics while receiving immunosuppressants for IMDC was associated with a greater risk of CDI. Further large-scale studies are warranted to clarify the role of CDI, antibiotics and immunosuppression treatment in IMDC patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clostridioides difficile infection in cancer patients receiving immune checkpoint inhibitors

Vasavada

Panneerselvam

Amin

et al. 2022

aog

View full text Add to dashboard Cite

show abstract

“…3 Interestingly, a recent study demonstrated that IBD patients with suspected CDI, who tested positive with a toxin-based assay when compared to a toxin negative but PCR positive had a higher rate of antibiotic response and a lower rate of requiring IBD therapy escalation. 44 In the general non-IBD population, colonoscopy is infrequently required to diagnose CDI. In contrast, IBD patients who develop a flare or CDI; frequently undergo a lower gastrointestinal examination to evaluate the disease status of the IBD.…”

Section: Diagnostic Dilemmas For CDI In Ibdmentioning

confidence: 99%

“…Potentially, this strategy would identify true CDI and is likely the preferred diagnostic modality to detect CDI in IBD patients due to non-reliability of symptoms [ 3 ]. Interestingly, a recent study demonstrated that IBD patients with suspected CDI, who tested positive with a toxin-based assay when compared to a toxin negative but PCR positive had a higher rate of antibiotic response and a lower rate of requiring IBD therapy escalation [ 44 ].…”

Section: Diagnostic Dilemmas For CDI In Ibdmentioning

confidence: 99%

Management of Clostridioides difficile infection in patients with inflammatory bowel disease

Khanna

2021

Intest Res

View full text Add to dashboard Cite

tered gut microbiota is colonization and infection with opportunistic microorganisms such as Clostridioides difficile. Studies over the years have demonstrated that the commonest infectious complication and the leading cause of a disease flareup in patients with IBD is C. difficile infection (CDI). 3 In contrast, non-C. difficile bacterial infections are uncommon in IBD patients with a disease flare. 4 Clostridioides difficile (formerly Clostridium difficile also known as C. difficile or C. diff) is an anaerobic Gram-positive spore forming bacterium that is ubiquitous in our environment. 5 Exposure to the C. difficile bacterium (spore or vegetative form) can lead to spectrum of outcomes ranging from no effect and no colonization to asymptomatic colonization to mild-moderate illness to severe diarrhea to fulminant lifethreatening infection. 6 It is now well-recognized that IBD patients are at a high risk of developing CDI even in the absence of other traditional risk factors. 3 In 2017, the American Gastroenterological Association released an expert clinical practice

show abstract

“…Only recently however has real world clinical evidence emerged demonstrating a superiority of a test and treat strategy directed by toxin-positive assay over PCR testing for suspected CDI in the IBD population. Gupta et al in a study of 92 IBD patients (61% Crohn’s disease), of whom 28 (30%) where toxin-positive, found that 82% of toxin-positive patients responded to antibiotics directed against CDI compared to only 25% of toxin-negative PCR-positive patients (P < 0.001), and that only 21 % of toxin-positive patients required IBD therapy escalation compared to 63% of toxin-negative PCR-positive patients (P < 0.001) [ 5 ].…”

Section: To the Editormentioning

confidence: 99%

Clostridiodes difficile Treatment Guided by Polymerase Chain Reaction Stool Testing Does not Alter Outcomes for Patients With Inflammatory Bowel Disease

Chandrabos¹,

Chin²,

Liu³

et al. 2021

J Clin Med Res

View full text Add to dashboard Cite

Diagnostic Modality of Clostridioides difficile Infection Predicts Treatment Response and Outcomes in Inflammatory Bowel Disease

Cited by 11 publications

References 19 publications

Clostridioides difficile infection in cancer patients receiving immune checkpoint inhibitors

Clostridioides difficile infection in cancer patients receiving immune checkpoint inhibitors

Management of Clostridioides difficile infection in patients with inflammatory bowel disease

Clostridiodes difficile Treatment Guided by Polymerase Chain Reaction Stool Testing Does not Alter Outcomes for Patients With Inflammatory Bowel Disease

Contact Info

Product

Resources

About