Fecal calprotectin in management of <i>Clostridium difficile</i> infection: a longitudinal study

Gallo, Antonella; Vallone, Carla Vincenza; Sabatelli, Ludovico; Ventura, G.; Covino, Marcello; Cammarota, Giovanni; Gasbarrini, Antonio; Landolfi, Raffaele; Montalto, Massimo

doi:10.1080/00365521.2017.1392598

Cited by 10 publications

(4 citation statements)

References 24 publications

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“…Data reported from the literature state that FC closely correlates with acute bacterial diarrhea, and among all causes of infectious diarrhea, CDI accounts for its the highest values 17 . As evidenced by our previous longitudinal study, 11 FCC directly correlates with the clinical course of infection being a reliable indicator of the likelihood of response to standard medical therapy. Hence, it is likely that FC may play a key role in the management of FMT in CDI.…”

Section: Discussionsupporting

confidence: 56%

“…In the context of CDI, higher levels of FC have been found in C. difficile ‐associated diarrhea compared with other causes of infectious diarrhea 10 . Moreover, our previous longitudinal study showed a close association between fecal calprotectin concentrations (FCCs) and the clinical response of CDI patients treated with standard antibiotic therapy 11 …”

Section: Introductionmentioning

confidence: 92%

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Fecal calprotectin and need of multiple microbiota trasplantation infusions in Clostridium difficile infection

Gallo

Cancelli

Ceron

et al. 2020

J of Gastro and Hepatol

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Background and Aim Fecal microbiota transplantation (FMT) has proven to be very effective in recurrent Clostridium difficile infection (CDI) when compared with standard antibiotic therapy. However, given the lack of validated criteria, decision regarding number and timing of infusions is currently based on the clinician's experience, severity of infection, and clinical response. We performed a longitudinal assessment of fecal calprotectin concentration (FCC) in CDI patients undergoing FMT. FCCs were correlated with the need for multiple infusions and with the clinical status of the patient. Methods Fecal calprotectin concentration measurement was performed just before first procedure (T0) and 2 (T1) and 5 (T2) days later. The need for reinfusion was accounted for in the 8 weeks following procedure, and clinical status was evaluated at the end of the given period. Both outcomes were correlated with measured FCCs. Results A total of 28 CDI patients undergoing FMT were enrolled. Median FCCs at T0 were significantly higher in patients who needed repeat FMT, 540 μg/g versus patients who underwent single FMT, 290 μg/g (P < 0.05). Differences were not significant for FCC at T1 and T2. Regarding correlation with clinical outcome, median FCC at T0 was found to be lower in responders compared with non‐responders with a trend towards statistical significance (P = 0.07). Correlation at T1 and T2 was not significant. Conclusions The use of an easily obtainable parameter such as fecal calprotectin could possibly optimize overall management of FMT procedural framework potentially being able to immediately identify patients who may benefit from repeat infusions.

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Section: Discussionsupporting

confidence: 56%

Section: Introductionmentioning

confidence: 92%

Fecal calprotectin and need of multiple microbiota trasplantation infusions in Clostridium difficile infection

Gallo

Cancelli

Ceron

et al. 2020

J of Gastro and Hepatol

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“…The idea that fCP can help to distinguish patients who need specific treatment against C. difficile is biologically plausible since fCP is a marker of intestinal inflammation. In fact, several studies have reported much higher fCP concentrations in patients with severe CDI than in patients with mild CDI [22,23,27,28]. In addition, Barbut et al found a higher concentration of fCP in patients with a toxin detectable by means of a cytotoxicity assay than in those with no free toxin, suggesting the possible role of fCP in the treatment decision [29].…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Fecal Calprotectin in the Management of Patients with Toxigenic Clostridioides difficile

Suarez-Carantoña

Rodriguez-Torres

Viteri-Noel

et al. 2021

JCM

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The availability of highly sensitive molecular tests for the detection of Clostridioides difficile in feces leads to overtreatment of patients who are probably only colonized. In this prospective study, the usefulness of fecal calprotectin (fCP) is evaluated in a cohort of patients with detection of toxigenic C. difficile in feces. Patients were classified by an infectious diseases consultant blinded to fCP results into three groups—group I, presumed Clostridioides difficile infection (CDI); group II, doubtful but treated CDI; and group III, presumed C. difficile colonization or self-limited CDI not needing treatment. One hundred and thirty-four patients were included. The median fCP concentrations were 410 (138–815) μg/g in group I, 188 (57–524) μg/g in group II, and 51 (26–97) μg/g in group III (26 cases); p < 0.05 for all comparisons. In forty-five out of 134 cases (33.5%), the fCP concentrations were below 100 µg/g. In conclusion, fCP is low in most patients who do not need treatment against C. difficile, and should be investigated as a potentially useful test in the management of patients with detected toxigenic C. difficile.

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“…Wyniki naszych badań wykazały zróżnicowany poziom stężenia kalprotektyny w przewodzie pokarmowym u osób z zakażeniem C. difficile, przy czym najniższe z tych stężeń było 4-krotnie wyższe niż górna granica przyjęta dla osób zdrowych (50 µg/g kału). W badaniach innych autorów stężenia kałowej kalprotektyny były istotnie wyższe u pacjentów z CDI, niż u osób, u których przyczyna biegunki była inna, oraz u osób zdrowych (1,5,7,13,15).…”

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Assessment of fecal calprotectin concentration in samples from patients with Clostridium difficile infection

et al. 2018

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Introduction: Clostridium difficile infection (CDI) can cause of nosocomial diarrhoea and intestinal inflammation. Fecal calprotectin (fc) is a sensitive marker of intestinal inflammation, found to be associated with enteric bacterial infections as C. difficile infection (CDI). Materials and Methods: We evaluated faecal calprotectin (fc) levels using a Ridascreen® Calprotectin test (R-Biopharm AG) in faecal samples of CDI positive patients diagnosed by C. Diff Quik Chek Complete (TechLab; Blacksburg, VA, USA and Alere; Waltham, MA, USA) test. Statistical analysis was performed for correlation of fc levels with infection with different C. difficile PCR-ribotypes (RTs). The study involved two groups of faecal samples: 58 samples with glutamate dehydrogenase (GDH) plus TOX A/B positive and second group were 17 samples from healthy adults without diarrhoea and GDH/TOX A/B negative. All samples (n=75) were plated on CLO selective agar (bioMérieux, Marcy l’Etoile, France) to grow a C. difficile strain. RTs was defined using specific primers. Results: From 75 stool samples, 47 strains of C. difficile were cultured only from diarrheal patients. In 58 diarrhoeic stool samples, the range of calprotectin concentrations were 199.7-1137.15 μg/g (>150μg/g, elevated concentration), which indicates on inflammatory process. C. difficile strains belonged to the following RTs: RT 027 (n=39), RT 020 (n=4), RT 176 (n=2), RT 001 (n=1) and RT 017 (n=1). In the 17 samples from the healthy adults, the range of calprotectin concentrations was 12.1-25.3 μg/g stool (FC normal concentration C. difficile strain was not cultured. Conclusions: The study found a differentiated level of calprotectin in the gastrointestinal tract in patients with CDI. There were no statistically significant differences in the concentration of calprotectin between patients infected with RT027 and different PCR ribotypes than RT027 (p >0,05). However, it should be emphasized that these tests carried out on a small number of samples. Examination of relationship between level of calprotectin and genetic type of C. difficile causing CDI requires further investigation.

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Fecal calprotectin in management of Clostridium difficile infection: a longitudinal study

Cited by 10 publications

References 24 publications

Fecal calprotectin and need of multiple microbiota trasplantation infusions in Clostridium difficile infection

Fecal calprotectin and need of multiple microbiota trasplantation infusions in Clostridium difficile infection

Usefulness of Fecal Calprotectin in the Management of Patients with Toxigenic Clostridioides difficile

Assessment of fecal calprotectin concentration in samples from patients with Clostridium difficile infection

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