Comparative frequency of Clostridial infection in patients with ulcerative colitis receiving mesenchymal stromal cells and biological preparations

BACKGROUND: Patients with inflammatory bowel disease (IBD) experienced more frequent development of Clostridial infection and much higher rates of morbidity and mortality compared to patients without IBD. Risk factors are immunosuppressive therapy.
 

METHODS: The aim is to compare the frequency of Clostridial infection (CI) in patients with ulcerative colitis (UC) receiving bone marrow mesenchymal stromal cells (MSC) and biological therapy.
Materials and methods. The patients were divided into three groups: the first group (n = 23) received the MSCs culture according to the scheme (0-1-2 weeks, then every 26 weeks); the second group of patients with UC (n = 21) received infliximab (IFX) in combination with azathioprine (AZA) according to the recommended scheme, the third group received only IFX according to the scheme. The toxins A and B of Clostridium difficile were determined by the enzyme immunoassay in the stool. The comparative analysis was carried out using the method of four-field tables using nonparametric statistical criteria.
 

RESULTS: In patients of the 1-st group, toxin A was detected in 1/23 patients (4.3%), in the 2-nd group - in 2/21 (9.5%) (RR - 0.45, 95% CI 0.04 -4.6, x2 -0.46, p>0.05), in the third - in 2/18 (11.1%) (RR-0.4, 95% CI 0.04-3.98, x2- 0.7, p>0.05). In patients of the 1-st group, toxin B was detected in 2/23 patients (8.6%), in the second group in 3/21 (14.3%) patients (RR -0.6, 95% CI 0, 1-3.3, x2 -0.3, p>0.05), in the third - in 2/18 (11.1%) (RR-0.8, 95% CI 0.12-5, 03; x2 -0.07; p>0.05). In patients of the 1-st group toxins A and B were not detected - 0/23 (0,0%), in the 2-nd group toxins A and B were detected in 7/21 (33.3%) patients (x2 - 9.5, p<0.05), in the third - in 5/18 (27.8%) (x2 -7.3, p<0.05). Totally in patients of the 1-st group, Clostridium difficile toxin A and B was detected in 3/23 patients (13.1%), in the second group - in 12/21 (57.1%) patients with UC (RR-0.23, 95 % CI 0.075-0.7, x2 -9.5, p <0.05), in the third - in 9/18 (50.0%) (RR-0.26, 95% CI 0.08- 0.82, x2 -6.6, p<0.05).

CONCLUSION(S):  The frequency of Clostridial infection in patients with ulcerative colitis receiving mesenchymal stromal cells is significantly lower than in patients with ulcerative colitis receiving biological immunosuppressive preparations.