Abstract
The availability of highly sensitive molecular tests for the detection of Clostridioides difficile in feces leads to overtreatment of patients who are probably only colonized. In this prospective study, the usefulness of fecal calprotectin (fCP) is evaluated in a cohort of patients with detection of toxigenic C. difficile in feces. Patients were classified by an infectious diseases consultant blinded to fCP results into three groups—group I, presumed Clostridioides difficile infection (CDI); group II, doubtful but treated CDI; and group III, presumed C. difficile colonization or self-limited CDI not needing treatment. One hundred and thirty-four patients were included. The median fCP concentrations were 410 (138–815) μg/g in group I, 188 (57–524) μg/g in group II, and 51 (26–97) μg/g in group III (26 cases); p < 0.05 for all comparisons. In forty-five out of 134 cases (33.5%), the fCP concentrations were below 100 µg/g. In conclusion, fCP is low in most patients who do not need treatment against C. difficile, and should be investigated as a potentially useful test in the management of patients with detected toxigenic C. difficile.
Highlights
Clostridioides difficile is the leading cause of nosocomial infectious diarrhea and is one of the most prevalent nosocomial pathogens [1]
C. difficile in feces were considered for the study, except those diagnosed with pathologies that increase fecal calprotectin (fCP), such as inflammatory bowel disease, ischemic colitis, or colitis due to other enteropathogens
A 3-step diagnostic algorithm was applied for the detection of toxigenic C. difficile in fecal samples based first on the detection of glutamate dehydrogenase (GDH) using an enzyme immunoassay (EIA)
Summary
Clostridioides difficile is the leading cause of nosocomial infectious diarrhea and is one of the most prevalent nosocomial pathogens [1]. Its incidence has increased in recent decades, and it is associated with a significant impact on health and costs [2]. The administration of oral vancomycin is associated with profound changes in the microbiota that lead to an increased risk of colonization by enterococci, multi-resistant gram-negative bacilli and Candida spp. A recent trial has shown that the treatment of colonized patients with vancomycin does not clear C. difficile [6]. New, high-cost treatments such as fidaxomicin and bezlotoxumab are indicated in patients with a high risk of recurrence [7,8]. In cases of multiple recurrence, the treatment of choice is fecal microbiota transplantation, a treatment that should not be prescribed lightly [9]
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