The triggering role of Clostridioides difficile infection in relapsed IBD outpatients

Although the exact aetiology of inflammatory bowel disease (IBD) is unknown, one hypothesis suggests that the inflammation may be the consequence of an altered or pathogenic microbiota in a genetically susceptible host. The aim of this study was to assess the frequency of enteral infections in patients with relapse of IBD, and to evaluate the clinical utility of faecal calprotectin (FC) and faecal matrixmetallopro-teinase-9 (MMP-9) in the differential diagnosis of relapses with different origins, and to determine the recurrence rate of Clostridioides difficile (C. difficile) , the hospitalisation and colectomy rate among C. difficile positive IBD patients at the end of 4 years follow-up period. Methods: In this prospective, “real life” study clinical data, serum and stool samples were assessed. Results: Overall, 135 outpatients with IBD were enrolled [91 IBD patients who relapsed and 44 subjects in clinical remission (control group)]. C. difficile A/B toxins were detected in 42.2% of all cases. Candida was presented in 9.9% among the enrolled subjects. We found significant difference between FC and MMP-9 values in patients in relapse and remission, but not in C. difficile positive and negative cases. Our results revealed an association between previous antibiotic use and the rate of toxigenic C. difficile . Toxigenic C. difficile positivity recurrence rate was 4.4%. Hospitalisation during follow-up due to IBD was 45.4% and 35% in C. difficile positive and negative group, respectively. Value of FC and MMP-9 did not predict the need of hospitalisation. Conclusions: The occurrences of toxigenic C. difficile and Candida positivity were excessively high in our patients in an acute relapse, which suggests the importance of intestinal microbiota in IBD. FC and MMP-9 has no diagnostic value to differentiate between infection-induced and natural relapse. In our study was confirmed that hospitalisation rate was higher in C. difficile positive cases, but we did not find any relationship on long-term period.