Does Clostridioides difficile infection play a role in premalignant colonic lesions? A retrospective cohort study

Clostridioides difficile infection (CDI) and colorectal cancer pose significant health risks in the US, and yet the potential link between them remains unexplored in humans. We aim to investigate the association between CDI and the risk of developing premalignant and malignant colonoscopic findings in adult patients in inpatient and outpatient settings.

This retrospective cohort study reviewed patient charts from four healthcare facilities, including two tertiary referral centers. A total of 448 adult patients who underwent C. difficile tests (CDT) during the approved timeframe and had colonoscopies completed at least 5 years after CDT were identified using the Clostridium difficile PCR test and International Classification of Diseases codes. Our primary outcome was the rate of premalignant and malignant polyps or masses documented on colonoscopy reports greater than or equal to 5 years from the initial CDT date. Overall lesion frequency, size, histology, and presence of ulcerations were secondary outcomes.

There was no significant difference in the development of polyps and masses between the patients with CDT-positive and CDT-negative [odds ratio (OR) = 1.21, 95% confidence interval (CI) = 0.70-2.11). In addition, the presence of malignant and premalignant histology also did not differ. CDT-positive group had a greater frequency of ulcerative lesions compared to the CDT-negative even after stratification for smoking (OR = 6.15, 95% CI = 1.67-22.66).

Although no significant association was found between CDI and malignant or premalignant lesions, the study sheds light on the potential link between CDI and inflammatory pathologies such as ulcerative colorectal lesions. It could influence colorectal cancer screening strategies for patients with CDI.