ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2013
Markers of intestinal inflammation, not bacterial burden, correlate with clinical outcomes in Clostridium difficile infection.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 121 papers, 4 of them syntheses that pooled it.
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Who cites it
121 citing papers in PubMed, 4 syntheses or guidelines pooled it, 173 citations in OpenAlex.
- Clinical significance of toxin EIA positivity in patients with suspectedJournal of clinical microbiology · 2025Pooled it
- Systematic Review on the Correlation of Quantitative PCR Cycle Threshold Values of Gastrointestinal Pathogens With Patient Clinical Presentation and Outcomes.Frontiers in medicine · 2021Pooled it
- Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA).Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2018Guideline
- Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections.World journal of gastroenterology · 2016Pooled it
- A possible association between statin use and improved Clostridioides difficile infection mortality in veterans.PloS one · 2019Trial
- Phenotypic profiling of neutrophils in acuteGut microbes · 2026Article
- Review
- Balancing act of cytokines in controlling the severity ofInfection and immunity · 2026Review
- Phase variable colony morphotypes ofInfection and immunity · 2026Article
- Colonic epithelial regeneration shapes susceptibility tobioRxiv : the preprint server for biology · 2026Article
- Gut microbiome and metabolome signatures in calcium oxalate stone recurrence: a multi-omics study.Microbial cell factories · 2026Article
- Olfactomedin-4Infection and immunity · 2026Article
- Phase variable colony morphotypes ofbioRxiv : the preprint server for biology · 2026Article
- Observational
- Proton pump inhibitors and the risk of hospital acquired clostridioides difficile infection in critically ill patients.Frontiers in pharmacology · 2026Article
- Metabolic plasticity enables Clostridioides difficile growth in coculture with neutrophils and other mammalian cells.Anaerobe · 2025Article
- Lipidomics, Microbiota, and IntestinalInternational journal of molecular sciences · 2025Review
- The Impact of Obesity onJournal of clinical medicine · 2025Article
- IL-33 protects from recurrent C. difficile infection by restoration of humoral immunity.The Journal of clinical investigation · 2025Article
- Therapeutic activation of IL-22-producing innate lymphoid cells enhances host defenses to Clostridioides difficile infection.Cell reports · 2025Article
61 more citing papers are in PubMed but not listed here.
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundClostridium difficile is a leading hospital-acquired infection. Many patients remain symptomatic for several days on appropriate antibiotic therapy. To assess the contribution of ongoing infection vs persistent inflammation, we examined the correlation between fecal cytokine levels, fecal C. difficile burden, and disease outcomes in C. difficile infection (CDI).
methodsWe conducted a prospective cohort study in Barnes Jewish Hospital between June 2011 and May 2012 of hospitalized adults with CDI. We determined fecal interleukin 8 (IL-8) and lactoferrin protein concentrations by enzyme immunoassay. We used real-time polymerase chain reaction (PCR) to measure relative fecal IL-8 and CXCL-5 RNA transcript abundances, and quantitative PCR to enumerate C. difficile burden.
resultsOf 120 study subjects, 101 (84%) were started on metronidazole, and 33 of those (33%) were subsequently given vancomycin. Sixty-two (52%) patients had diarrhea persistent for 5 or more days after starting CDI therapy. Initial fecal CXCL-5 messenger RNA (mRNA), IL-8 mRNA, and IL-8 protein correlated with persistent diarrhea and use of vancomycin. Time to diarrhea resolution was longer in patients with elevated fecal cytokines at diagnosis. Fecal cytokines were more sensitive than clinical severity scores in identifying patients at risk of treatment failure. Clostridium difficile burden did not correlate with any measure of illness or outcome at any point, and decreased equally with metronidazole and vancomycin.
conclusionsPersistent diarrhea in CDI correlates with intestinal inflammation and not fecal pathogen burden. These findings suggest that modulation of host response, rather than adjustments to antimicrobial regimens, might be a more effective approach to patients with unremitting disease.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.