Clostridioides difficile infection (CDI) rates and outcomes can vary based on differences in testing strategy. Our aim was to assess the prevalence of toxin detection in inflammatory bowel disease (IBD) when compared to those without IBD. Secondly, the clinical outcomes of CDI in IBD were assessed using two-step testing strategies. We included patients undergoing CDI testing from four academic centers in the United States between January 1, 2018 and June 30, 2020. First the prevalence of toxin detection was compared between individuals with IBD and those without IBD. Secondly, among patients with IBD a primary composite outcome of abdominal colectomy, admission to an intensive care unit (ICU) or death within 30 days of C. difficile testing was assessed across the three categorical groups (screen positive/toxin positive, screen positive/toxin negative and screen negative assay) resulting from the two-step testing strategy. When comparing individuals with a positive screening assay, patients with IBD were less likely to have toxin detected by enzyme immunoassay (EIA) as compared to the non-IBD population (22/145 (15.2%) vs. 413/1144 (36.1%), p < 0.0001). Among all patients with IBD (n = 300), twenty-five (8.3%) had a screen positive assay/toxin positive assay, 136 (45.3%) had a screen positive/toxin negative assay and 139 (46.3%) had a negative screening assay. No significant difference in the primary composite outcome was detected across the three groups (p = 0.566). When compared to those without IBD, patients with IBD have a reduced proportion of cases of C. difficile with toxin positivity. Differences in clinical outcomes among patients with IBD were not detected and limited by the infrequent detection of expressed toxin.

中文翻译：

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艰难梭菌毒素在炎症性肠病中很少检测到，并且与临床结果无关

艰难梭菌感染 (CDI) 率和结果可能因检测策略的差异而异。我们的目的是评估与没有 IBD 的患者相比，炎症性肠病 (IBD) 中毒素检测的流行率。其次，使用两步测试策略评估 IBD 中 CDI 的临床结果。我们纳入了 2018 年 1 月 1 日至 2020 年 6 月 30 日期间在美国四个学术中心接受 CDI 检测的患者。首先比较了 IBD 患者和非 IBD 患者的毒素检测流行率。其次，在 IBD 患者中，在三个分类组（筛查阳性/毒素阳性、筛选阳性/毒素阴性和筛选阴性测定）由两步测试策略产生。在比较具有阳性筛查测定的个体时，与非 IBD 人群相比，IBD 患者通过酶免疫测定 (EIA) 检测到毒素的可能性较小（22/145 (15.2%) 与 413/1144 (36.1%) , p < 0.0001)。在所有 IBD 患者（n = 300）中，25 名（8.3%）筛查阳性/毒素阳性检测，136 名（45.3%）筛查阳性/毒素阴性检测，139 名（46.3%）阴性筛选试验。三组的主要复合结局没有显着差异（p = 0.566）。与没有 IBD 的患者相比，IBD 患者的毒素阳性艰难梭菌病例比例降低。