Patients with cystic fibrosis have a high carriage rate of non-toxigenic Clostridium difficile

Abstract

Thirty-year-old observations report frequent asymptomatic Clostridium difficile carriage among cystic fibrosis (CF) patients. In this case-control study, we found more carriers among CF patients than controls (47% versus 11%), but most strains carried by CF patients were non-toxigenic (77% versus 17%). Among CF patients, carriers were younger, with more severe pulmonary disease than non-carriers. Strains belonged to multiple PCR-ribotypes, suggesting that these CF patients did not acquire strains from each other.

Clostridium difficile Infection in Hospitalized Patients with Cystic Fibrosis

“…Patients with CF had a higher risk for CDI after matching for demographic characteristics and comorbidities (odds ratio [95% confidence interval (CI)], 3.0 [2.6-3.5]) and in patients with CF and lung transplantation (1,849 hospital discharges), the incidence was even higher (3.1% vs 1.4%; This study represents, to our knowledge, the first use of multi-institutional data to investigate CDI in patients with CF. Contrary to earlier reports, 1,6 patients with CF 18-44 years of age demonstrated a threefold greater risk for developing CDI than age-matched control subjects; individuals with CF and lung transplantation were especially vulnerable. In our study population of hospitalized patients with CF, CDI was associated with overall worse outcomes and an increased incident trend of disease.…”

“…Interpreting a C. difficile-positive test result for patients with CF is difficult given a high rate of asymptomatic carriage in this population. 1,6 However, it is unusual to perform CDI testing in the absence of diarrhea, and we believe our patients represented true infection and not colonization. We conclude that CDI is a significant complicating factor in hospitalized adults with CF who are at risk of more severe disease; early diagnosis and aggressive treatment is imperative.…”

High prevalence of subclass-specific binding and neutralizing antibodies against <em>Clostridium difficile</em> toxins in adult cystic fibrosis sera: possible mode of immunoprotection against symptomatic <em>C. difficile</em> infection

“…These findings raise the possibility that patients with cystic fibrosis are able to mount more effective secondary B-cell immune responses that encode protective anti-toxin neutralizing antibodies compared with patients with C. difficile infection. Colonization with non-toxigenic C. difficile may also protect against colonization with toxigenic strains and may partially explain why patients with cystic fibrosis seldom develop symptomatic C. difficile infection 9,20. Moreover, it is conceivable that differences in colonic mucus or microbiome may protect patients with cystic fibrosis from C. difficile infection.…”

Gastrointestinal and Hepatobiliary Disease in Cystic Fibrosis

“…It is important to note that asymptomatic C. difficile carriage rates of up to 47% have been described in CF patients; however, 77% of the strains identified were nontoxigenic. 110 When patients with CF do develop C .difficile associated colitis, they often do not present with the classic symptom of diarrhea. Patients more commonly present with abdominal pain and distention, rapidly progressing to toxic megacolon.…”