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

Abstract

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.

The value of fecal calprotectin in Clostridioides difficile infection: A systematic review

“… Suarez-Carantoña et al (2021) divided patients into three groups: group I, recommended treatment for hypothetical CDI; group II, uncertain diagnosis but patients treated for CDI; and group III, assumed C. difficile colonization or self-limiting CDI that did not require treatment according to the recommendations of clinicians and professional consultants. After comparing the fCP levels of the three groups of patients, it was found that the fCP levels of the patients in group I were significantly higher than those in the other two groups.…”

“…In addition, even a positive toxin test result does not always mean a patient’s need for treatment. Suarez-Carantoña et al (2021) divided patients into those with hypothetical CDI for whom treatment was recommended, those with indeterminate diagnosis but received CDI therapy, and those with C. difficile colonization or self-limiting CDI who did not require treatment. After comparing levels of fCP in the three groups of patients, it was found that fCP levels were significantly higher in patients who required treatment than in those who did not.…”

Microbiome profile and calprotectin levels as markers of risk of recurrent Clostridioides difficile infection

“…We obtained statistically significantly higher levels of faecal calprotectin in severe episodes than in mild episodes, consistent with previous studies, which reported significant results between calprotectin levels and the severity of the CDI episode. ( Barbut et al., 2017 ; Kim et al., 2017 ; Han et al., 2020 ; Suarez-Carantoña et al., 2021 ). However, few studies have investigated the relationship between calprotectin levels and risk of developing R-CDI: those that did showed no significant association between R-CDI and calprotectin levels, and most of them included a low number of patients studied or only included a specific subpopulation such as children or cancer patients ( Swale et al., 2014 ; Peretz et al., 2016 ; Nicholson et al., 2017 ; He et al., 2018 ).…”

“…Calprotectin is a protein secreted mainly by neutrophils, but also by macrophages, monocytes and dendritic cells ( Odink et al., 1987 ; Edgeworth et al., 1991 ; Kumar et al., 2003 ). It is known to be a good marker of intestinal inflammation, can be obtained non-invasively and is stable at room temperature ( Xu and Geczy, 2000 ; Lasson et al., 2015 ).Several studies have examined the role of calprotectin as a marker of severity of CDI with calprotectin levels being higher the more severe the CDI episode ( Peretz et al., 2016 ; Kim et al., 2017 ; Suarez-Carantoña et al., 2021 ) and as a marker of CDI itself with higher levels of calprotectin in patients with CDI than in patients without CDI ( Popiel et al., 2015 ; Barbut et al., 2017 ).…”