Intestinal Research

Original Articles

Infection

Rapid and accurate diagnosis of Clostridium difficile infection by real-time polymerase chain reaction: Pil Hun Song, Jung Hwa Min, You Sun Kim, Soo Yeon Jo, Eun Jin Kim, Kyung Jin Lee, Jeonghun Lee, Hyun Sung, Jeong Seop Moon, Dong Hee Whang; Intest Res 2018;16(1):109-115. Published online January 18, 2018; DOI: https://doi.org/10.5217/ir.2018.16.1.109

Background/Aims

The incidence and severity of Clostridium difficile infection (CDI) have increased worldwide, resulting in a need for rapid and accurate diagnostic methods.

Methods

A retrospective study was conducted to compare CDI diagnosis methods between January 2014 and December 2014. The stool samples, which were obtained in presumptive CDI patients, were compared for their diagnostic accuracy and rapidity, including real-time polymerase chain reaction (PCR) of toxin genes, C. difficile toxin assay, and culture for C. difficile.

Results

A total of 207 cases from 116 patients were enrolled in this study and 117 cases (56.5%) were diagnosed as having CDI. Among the 117 cases, the sensitivities of real-time PCR, C. difficile toxin assay, and culture for C. difficile were 87.2% (102 cases; 95% CI, 80.7%–92.8%), 48.7% (57 cases; 95% CI, 41.0%–59.8%), and 65.0% (76 cases; 95% CI, 60.2%–78.5%), respectively (P<0.005). Notably, 34 cases (29.0%) were diagnosed with CDI by real-time PCR only. The time required to obtain results was 2.27 hours (136.62±82.51 minutes) for real-time PCR, 83.67 hours (5,020.66±3,816.38 minutes) for toxin assay, and 105.79 hours (6,347.68±3,331.46 minutes) for culture (P<0.005), respectively.

Conclusions

We confirmed that real-time PCR of toxin genes is the most effective diagnostic method for accurate and early diagnosis of CDI. It also helps to diagnose hypervirulent CDI, such as ribotype 027 infection.

Citations

Citations to this article as recorded by

Clostridium Difficile Infection in Childhood: Case Series
P. Parusheva, L. Pekova, S. Angelova, B. Bureva
Acta Medica Bulgarica.2025; 52(s1): 98. CrossRef
Usefulness of Stool Multiplex Polymerase Chain Reaction Assays in Patients with Acute Diarrhea
Seo Hyun Kim, You Sun Kim, Seung Hyuk Kim, Won Eui Yoon, Hee Jun Myung, Jeong Seop Moon, Dong Hee Whang
The Korean Journal of Gastroenterology.2022; 79(3): 118. CrossRef
Persistent Leg Drainage in a Pediatric Trauma Patient
Ashley Howard, Michelle R. Rychalsky, Thomas S. Murray
Pediatric Infectious Disease Journal.2021; 40(6): 597. CrossRef
Real-Time Detection and Motion Recognition of Human Moving Objects Based on Deep Learning and Multi-Scale Feature Fusion in Video
Meimei Gong, Yiming Shu
IEEE Access.2020; 8: 25811. CrossRef
Temporal change of risk factors in hospital-acquired Clostridioides difficile infection using time-trend analysis
Jiyoun Song, Bevin Cohen, Philip Zachariah, Jianfang Liu, Elaine L. Larson
Infection Control & Hospital Epidemiology.2020; 41(9): 1048. CrossRef
Incidence and Characteristics ofClostridioides difficileInfection in Children
Heera Jeong, Ji-Man Kang, Jong Gyun Ahn
Pediatric Infection & Vaccine.2020; 27(3): 158. CrossRef
RecurrentClostridium difficileInfection: Risk Factors, Treatment, and Prevention
Jung Hoon Song, You Sun Kim
Gut and Liver.2019; 13(1): 16. CrossRef
Is Clostridium difficile infection a real threat in patients with ulcerative colitis? A prospective, multicenter study in Korea
Dae Bum Kim, Kang-Moon Lee, Sang Hyoung Park, You Sun Kim, Eun Soo Kim, Jun Lee, Sung-Ae Jung, Geom Seog Seo, Ji Min Lee
Intestinal Research.2018; 16(2): 267. CrossRef

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Long-Term Clinical Outcome of Clostridium difficile Infection in Hospitalized Patients: A Single Center Study: Young Seok Doh, You Sun Kim, Hye Jin Jung, Young Il Park, Jin Won Mo, Hyun Sung, Kyung Jin Lee, Young Ki Seo, Jeong Seop Moon, Seong Woo Hong; Intest Res 2014;12(4):299-305. Published online October 27, 2014; DOI: https://doi.org/10.5217/ir.2014.12.4.299

Abstract PDF PubReader ePub

Background/Aims

Antibiotic usage and increasingly aging populations have led to increased incidence of Clostridium difficile infection (CDI) in worldwide. Recent studies in Korea have also reported increasing CDI incidence; however, there have been no reports on the long-term outcomes of CDI. We therefore investigated the long-term clinical outcomes of patients with CDI, including delayed recurrence, associated risk factors and mortality.

Methods

Hospitalized patients diagnosed with CDI at Seoul Paik Hospital between January 2007 and December 2008 were included. Their medical records were retrospectively investigated. 'Delayed recurrence' was defined as a relapse 8 weeks after a successful initial treatment. Multivariate logistic regression analysis was performed to identify risk factors for the delayed recurrence. Kaplan-Meier curves were used to analyze mortality rates.

Results

A total of 120 patients were enrolled; among them, 87 were followed-up for at least 1 year, with a mean follow-up period of 34.1±25.1 months. Delayed recurrence was observed in 17 patients (19.5%), and significant risk factors were age (over 70 years, P=0.049), nasogastric tube insertion (P=0.008), and proton pump inhibitor or H₂-blocker treatments (P=0.028). The 12- and 24-month mortality rates were 24.6% and 32.5%, respectively. No deaths were directly attributed to CDI.

Conclusions

Delayed recurrence of CDI was not rare, occurring in 19.5% of the study population. Although CDI-related mortality was not reported, 2-year (32.5%) mortality rate of CDI patients implies that a CDI diagnosis may predict severe morbidity and poor prognosis of the underlying disease.

Citations

Citations to this article as recorded by

Global, regional, and national burdens of Clostridioides difficile infection over recent decades: a trend analysis informed by the Global Burden of Disease Study
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Microbiology Spectrum.2025;[Epub] CrossRef
Fecal microbiota composition is a better predictor of recurrent Clostridioides difficile infection than clinical factors in a prospective, multicentre cohort study
Tessel M. van Rossen, Yvette H. van Beurden, Johannes A. Bogaards, Andries E. Budding, Chris J.J. Mulder, Christina M.J.E. Vandenbroucke-Grauls
BMC Infectious Diseases.2024;[Epub] CrossRef
Clinical characteristics and outcomes of Clostridioides difficile infection in the intensive care unit: a KASID multi-centre study
J.E. Baek, I.H. Choi, Y.W. Cho, J. Kim, Y.J. Lee, M.C. Kim, K.O. Kim, Y-S. Cho
Journal of Hospital Infection.2023; 139: 106. CrossRef
Predictive Factors for Death among Patients with Clostridium difficile Infection – A Single Center Experience Study
Vlad A. Ionescu, Camelia C. Diaconu, Raluca S. Costache, Florentina Gheorghe, Andreea G. Andronesi, Gina Gheorghe
Romanian Journal of Military Medicine.2023; 126(4): 492. CrossRef
Review of the Impact of Biofilm Formation on Recurrent Clostridioides difficile Infection
Daira Rubio-Mendoza, Adrián Martínez-Meléndez, Héctor Jesús Maldonado-Garza, Carlos Córdova-Fletes, Elvira Garza-González
Microorganisms.2023; 11(10): 2525. CrossRef
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Infectious Diseases and Therapy.2021; 10(1): 201. CrossRef
A newly isolated E. thailandicus strain d5B with exclusively antimicrobial activity against C. difficile might be a novel therapy for controlling CDI
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Evaluation of Connecticut medical providers’ concordance with 2017 IDSA/SHEA Clostridioides difficile treatment guidelines in New Haven County, 2018–2019
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External validation of two prediction tools for patients at risk for recurrent Clostridioides difficile infection
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RBX7455, a Non-frozen, Orally Administered Investigational Live Biotherapeutic, Is Safe, Effective, and Shifts Patients’ Microbiomes in a Phase 1 Study for Recurrent Clostridioides difficile Infections
Sahil Khanna, Darrell S Pardi, Courtney Jones, William D Shannon, Carlos Gonzalez, Ken Blount
Clinical Infectious Diseases.2021; 73(7): e1613. CrossRef
Epidemiology of community-acquired and recurrent Clostridioides difficile infection
Yichun Fu, Yuying Luo, Ari M Grinspan
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Journal of Evidence-Based Medicine.2018; 11(1): 40. CrossRef
Rapid and accurate diagnosis of Clostridium difficile infection by real-time polymerase chain reaction
Pil Hun Song, Jung Hwa Min, You Sun Kim, Soo Yeon Jo, Eun Jin Kim, Kyung Jin Lee, Jeonghun Lee, Hyun Sung, Jeong Seop Moon, Dong Hee Whang
Intestinal Research.2018; 16(1): 109. CrossRef
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Proton Pump Inhibitors Should be Used with Caution in Critically Ill Patients to Prevent the Risk of Clostridium difficile Infection
Jung Hwa Min, You Sun Kim
Gut and Liver.2016; 10(4): 493. CrossRef
An Unusual Case of Proctitis and Rectal Abscess due to Irritants byArtemisia asiaticaSmoke (Ssukjwahun)
Seunghyup Kim, You Sun Kim, Seo Hyun Kim, Dong Hoon Lee, Se Jun Park, Seo Young Yun, Dae Young Kim, Jeonghun Lee, Jeong Seop Moon
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The Usefulness of a Colonoscopy with Biopsy in the Early and Accurate Diagnosis of Ischemic Colitis: Eui Joong Kim, Soon Man Yoon, Sang Hwa Lee, Ki Bae Kim, Joo Young Lee, Dong-Hwa Lee, Eun Bee Kim, Soonyoung Park, Joung Ho Han, Hee Bok Chae, Seon Mee Park, Sei Jin Youn, Ro Hyun Sung; Intest Res 2013;11(2):100-106. Published online April 30, 2013; DOI: https://doi.org/10.5217/ir.2013.11.2.100

Abstract PDF

Background/Aims
Ischemic colitis has a clinical spectrum ranging from mild reversible colitis to an acute fulminant course. Early and accurate diagnosis is therefore mandatory for a good clinical outcome. The aim of this study is to evaluate the efficacy and safety of a colonoscopy and histological examination with biopsy in the early and accurate diagnosis of ischemic colitis. Methods: We investigated the clinical characteristics and endoscopic findings with the histopathology of 89 cases of ischemic colitis from October 2002 to August 2012 in a tertiary-care hospital. All patients underwent a colonoscopy with biopsy within a few days of the onset of symptoms, and the histological features from the biopsy specimens were reviewed. In addition, the occurrence of complications by colonoscopy with biopsy was evaluated. Results: The mean age of the patients was 65.8±12.6 years (male:female, 1:2.2). The major combined disorders were hypertension (51.7%), diabetes (31.5%), and arrhythmia (19.1%). The clinical features usually presented with hematochezia (83.1%), abdominal pain (77.5%), and diarrhea (60.7%). The involved patterns were the left colon (56.2%), right colon (39.3%), and pancolon (4.5%). Based on the main histological features of ischemic colitis, including glandular atrophy (67.4%), hemorrhage (61.8%), capillary thrombi (42.7%), and coagulative necrosis of mucosa (29.2%), 67 of the 89 cases (75.3%) could be confirmed with ischemic colitis. There were no serious complications such as bowel perforation or major bleeding following the colonoscopy with biopsy. Conclusions: A colonoscopy with biopsy is beneficial and safe for the early and precise diagnosis of ischemic colitis. (Intest Res 2013;11:100-106)

Citations

Citations to this article as recorded by

What's the Clinical Features of Colitis in Elderly People in Long-Term Care Facilities?
So Yoon Yoon, Sung-Ae Jung, Sun-Kyung Na, Jae-In Ryu, Hye-Won Yun, Min-Jin Lee, Eun-Mi Song, Seong-Eun Kim, Hye-Kyung Jung, Ki-Nam Shim
Intestinal Research.2015; 13(2): 128. CrossRef
Author's Reply
Eui Joong Kim, Soon Man Yoon
Intestinal Research.2013; 11(3): 231. CrossRef
The Clinical Impact of Early Colonoscopic Biopsy in Ischemic Colitis
Young-Eun Joo
Intestinal Research.2013; 11(3): 229. CrossRef

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