Intest Res  
Is Clostridium difficile infection a real threat in patients with ulcerative colitis? A prospective, multicenter study in Korea
Dae Bum Kim1, Kang-Moon Lee1, Sang Hyoung Park2, You Sun Kim3, Eun Soo Kim4, Jun Lee5, Sung-Ae Jung6, Geom Seog Seo7, Ji Min Lee1
1Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 2Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 3Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, 4Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, 5Department of Internal Medicine, Chosun University Hospital, Chosun University College of Medicine, Gwangju, 6Department of Internal Medicine, Ewha Womans University Medical Center, Ewha Womans University School of Medicine, Seoul, 7Department of Internal Medicine, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea
Correspondence to: Kang-Moon Lee, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea. Tel: +82-31-249-8151, Fax: +82-31-253-8898, E-mail: drmaloman@catholic.ac.kr
Received: June 26, 2017; Revised: September 25, 2017; Accepted: October 19, 2017; Published online: January 30, 2018.
© Korean Association for the Study of Intestinal Diseases. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims: Clostridium difficile infection (CDI) has been reported to be a cause of flare-ups in patients with ulcerative colitis (UC). We evaluated the prevalence and clinical outcomes of CDI in patients with UC hospitalized for flare-ups. Methods: This was a prospective, multicenter study including 7 academic teaching hospitals in Korea. All consecutive patients with UC admitted for disease flare-up were enrolled. We detected the presence of CDI by using enzyme immunoassay, real-time polymerase chain reaction (RT-PCR) for toxin genes, and sigmoidoscopy. Results: Eighty-one consecutive patients with UC were enrolled from January 2014 to December 2015. Among 81 patients, 8 (9.9%) were diagnosed with CDI. Most of the cases were identified by RT-PCR. Enzyme immunoassay was positive in 3 of 8 patients, and only 1 had typical endoscopic findings of pseudomembranous colitis. There were no differences in demographic data, length of hospital stay, or colectomy rate between patients with and without CDI. Conclusions: CDI was not a rare cause of flare-up in patients with UC in Korea. However, CDI did not appear to affect the course of UC flare-up in Korean patients. RT-PCR was sensitive in detecting CDI and can be considered a diagnostic tool in patients with UC flare-up.
Keywords: Colitis, ulcerative; Clostridium infections; Prevalence; Polymerase chain reaction


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