연구성과 홍보

Dig Dis Sci. 2025 Aug;70(8):2794-2803.

Title : Clinical Outcome of Inflammatory Bowel Disease with Clostridioides difficile Polymerase Chain Reaction Toxin-Positive/Enzyme Immunoassay Toxin-Negative: A Retrospective Cohort Study

Authors : Junseok Park#1, Seulji Kim#2, Jong Pil Im3, Hyun Jung Lee3, Joo Sung Kim3, Hyunsun Park4, Yoo Min Han5, Seong-Joon Koh6,7*

Affiliations :

1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

2Department of Internal Medicine, Korea Institute of Radiological and Medical Sciences, Korea Cancer Center Hospital, Seoul, Korea.

3Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.

4Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.

5Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.

6Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.

7Department of Internal Medicine and Liver Research Institute, Laboratory of Intestinal Mucosa and SkinImmunology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea.

DOI: 10.1007/s10620-025-09045-4.

Abstract :

Background: Clostridioides difficile infection (CDI) frequently occurs concurrently in patients with inflammatory bowel disease (IBD), and differential diagnosis from IBD flares is critical. However, clinical management of C. difficile in IBD patients with polymerase chain reaction toxin-positive (tPCR+)/enzyme immunoassay toxin-negative (tEIA-) results has not yet been investigated.

Aims: We aimed to assess the clinical significance of C. difficile tPCR+/tEIA- in patients with IBD and the impact of antibiotic treatment on IBD outcomes.

Methods: This single-center, retrospective cohort study included patients with IBD with CDI test results between January 01, 2018, and August 01, 2022. First, the clinical outcomes of IBD, such as medication escalation, hospitalization, and surgery, were compared between patients with IBD with tPCR-/tEIA- and those with tPCR+/tEIA- using Cox regression and propensity score matching. Next, the clinical outcomes of IBD were assessed based on whether antibiotic treatment for CDI was administered to both groups.

Results: Among 412 patients with IBD with PCR test, 71 (17.2%) showed tPCR+/tEIA- results. The tPCR+/tEIA- group showed no statistically significant difference in IBD outcomes compared to the tPCR-/tEIA- group. The antibiotic-treated tPCR+/tEIA- group showed a higher risk of drug escalation and admission than the tPCR-/tEIA- group, while the antibiotic-untreated tPCR+/tEIA- group did not. After drug escalation during the follow-up, the treated tPCR+/tEIA- group showed IBD outcomes similar to those of the tPCR-/tEIA- group.

Conclusions: In patients with IBD with indeterminate CDI, the need for antibiotics should be thoroughly assessed and proper management of underlying IBD such as drug escalation may lead to favorable outcomes.