Search in the Abstract Database

Search Abstracts 2013

* = Presenting author

P703. A prospective study on Clostridium difficile infection, toxino type and antibiotic sensitivity in inflammatory bowel disease

M. Martinato1, A.R. Grillo1, R. D'Incà1, M. Scarpa2, R. Caccaro1, G.C. Sturniolo1, I. Castagluoilo1, 1Università degli Studi di Padova, Padova, Italy, 2Istituto Oncologico Veneto, Italy

Background

The importance of Clostridium difficile infection (CDI) in IBD pts is increasing because its effects could be masked by the underlying disease. The study is aimed to describe the frequency of CDI in IBD according to disease features, characterize C diff strains isolated from IBD pts (antibiotic sensitivity, toxin production profile, adhesion ability to colonic epithelium), identify possible risk factors for CDI and to assess the impact of CDI on IBD course both in symptomatic and asymptomatic carriers.

Methods

Stool samples have been collected from pts with IBD, age- and sex-matched healthy controls, non-IBD pts with CDAD. On each faecal sample an anaerobic culture followed by specific PCR was performed to identify C.difficile colonies. Each strain was characterized by toxin type by PCR, antibiotic sensitivity, adhesion to CACO cells, PCR for TcdC gene. Clinical data were collected in order to identify CDI risk factors.

Results

CDI was detected in

  • healthy controls: 4/55 (7%), all non toxigenic strains
  • IBD inpatients: 5/55 (9%), all strains toxigenic
  • IBD outpatients: 9/195 (9.7%) with 10 non toxigenic strains and 9 toxigenic strains (4.6%).

Profiles of toxin production are summarized in Table 1.

Antibiotic sensitivity is summarized in Table 2.

Univariate analysis did not identify any risk factors associated with CDI and CDI was not identified in the prospective part of the study as a risk factor for clinical relapse, surgery or endoscopic relapse. Adhesion ability is summarized in Figure 1.

Figure 1. Adhesion ability of C difficile strains to CACO cells.

Table 1. Toxin production profiles
ToxinsIBD outpatientsIBD inpatientsnon-IBD inpatients with CDAD
A B Bin3 (33%) 7 (39%)
A B5 (56%)4 (80%)7 (39%)
B Bin  4 (22%)
B1 (11%)  
A 1 (20%) 
Table 2. Antibiotic sensitivity according to recipient group
PatientsMetronidazoleCiprofloxacinVancomycin
Non-IBD inpatients0.39 mg/L>32 mg/L0.23 mg/L
IBD patients0.75 mg/L>32 mg/L1.50 mg/L
ANOVAnsnsp < 0.001

Conclusion

The risk of CDI in IBD patients is similar in UC and CD and no risk factors for CDI have been identified in IBD pts; asymptomatic carriers have the same risk of clinical or endoscopic relapse, surgery and therapy escalation as patients without CDI and CDI did not affect the course of underling IBD. Antibiotics in IBD patients (i.e Ciprofloxacine as monotherapy) should be used cautiously.