Bauer MP, Farid A, Bakker M et al.
Leiden University Medical Center, Leiden, The Netherlands.
Clin Microbiol Infect 2013 Nov 1; Epub ahead of print.
Paul Robinson’s review: The established risk factors for Clostridium difficile infection include exposure to healthcare institutions and the use of antibiotics, both of which are common in patients with cystic fibrosis (CF). Proton pump inhibitors are also commonly used by such patients, either for treating gastroesophageal reflux disease or to improve the efficiency of pancreatic enzyme action. While C difficile is an important cause of colitis and diarrhea, it may also be carried asymptomatically. Studies in the 1980s documented higher rates of C difficile carriage in the CF population compared with the general population. The authors of the current study sought to clarify current incidence rates in the CF population, perform molecular typing on the strains found (given reports of epidemic strains since the aforementioned studies), and investigate why CF subjects may not present with C difficile-related disease.
This study was performed at a single national adult CF center in The Netherlands over a 6-month period, screening all subjects within the clinic. Outpatients sent their stool samples by mail while inpatients had stool samples taken upon admission to the clinic. C difficile strains were characterized by polymerase chain reaction (PCR)-ribotyping and PCRs for C difficile toxin genes. Information on bowel habits was recorded in patient diaries and clinical details were obtained from medical records. Control samples were taken from inpatients at the internal medicine wards of a separate hospital. A total of 56 CF subjects and 108 controls were included in the study.