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P091. The detection of Clostridium difficile toxin A + B in inflammatory bowel disease on the background of immunosuppressive therapy

P091. The detection of Clostridium difficile toxin A + B in inflammatory bowel disease on the background of immunosuppressive therapy


L. Lazebnik1, V. Sagynbaeva1, O. Knyazev1, L. Efremov1, I. Ruchkina1

1Central Research Institute of Gastroenterology, Moscow, Russian Federation



Background: Long-term immunosuppressive therapy, suppressing the immune system may contribute to reactivation of Clostridium difficile toxin A+B.

Objective: To study the frequency of detection of Clostridium difficile toxin A+B in inflammatory bowel disease (IBD) on the background of long-term combined immunosuppressive therapy.

Methods: We examined 56 patients with chronic IBD constantly relapsing, with disease duration of 3 years or more, including 40 patients with ulcerative colitis (UC) (20 men, 20 women) and 16 – to Crohn's disease (CD) (5 men, 11 women). The mean age – 43.0±2.5 (M±m). Patients, depending on the therapy were divided into 3 groups: group 1 (10) Conducted transplant of mesenchymal stem cells (MSCs) in group 2 (20) – infliximab (IFX) treatment in group 3 (26) – by the therapy 5‑ASA, glucocorticosteroids, and/or systemic immunosuppressive agents. Clostridium difficile toxin A+B were determined in samples of faeces of patients with test kits “Seramun” Diagnostica GmbH (Germany).

Results: Among the 56 patients with IBD on the background of a prolonged and combined immunosuppressive therapy in 13 (23.2%) revealed Clostridium difficile toxin A+B, the average concentration was −0.618±0.11, at the rate of <0.348. Of the 40 patients with UC Clostridium difficile toxin A+B was detected in 9 (16.1%), while the average concentration was 0.687±0.16. Among the 16 patients with CD Clostridium difficile toxin A+B was detected in 4 (7.1%), the average concentration was 0.462±0.07.

In the group treated with infliximab, out of 20 patients with Clostridium difficile toxin A+B was detected in 5 (8.9%) receiving combination immunosuppressive therapy: 2 patients were treated with infliximab+systemic immunosuppressive agents and other two – infliximab+glucocorticosteroids, one – infliximab+systemic immunosuppressive agents, the average concentration of Clostridium difficile toxin A+B was their 0.777±0.29 (norm <0.348). In the group treated with MSCs – Clostridium difficile toxin A+B was detected in 2 gr. – (3.6%) during therapy with MSCs+ glucocorticosteroids, the concentration was 0.496±0.13 at a rate of <0.348. In the group treated with standard therapy among 26 patients with Clostridium difficile toxin A + B was detected in 6 (10.7%) patients (5-ASA+ glucocorticosteroids) concentration was – 0.525±0.04.

Conclusions: In patients with IBD Clostridium difficile toxin A+B is detected in 23.2% of cases. This fact should be considered when assigning a combination of prolonged immunosuppressive therapy.