A retrospective comparative study conducted at a tertiary infectious disease hospital in western China has identified distinct clinical characteristics among patients with rifampin-sensitive pulmonary tuberculosis who develop Clostridioides difficile infection, commonly known as CDI. The research, published in Frontiers in Cellular and Infection Microbiology, aimed to characterize the occurrence of CDI in this specific population and explore clinical factors associated with its development.

The study included 30 adults hospitalized with rifampin-sensitive pulmonary tuberculosis between June 2024 and January 2025, comparing ten patients with clinically diagnosed, PCR-positive CDI with 20 contemporaneous tuberculosis patients without CDI. The researchers extracted demographic characteristics, clinical manifestations, laboratory parameters, medication exposure, and in-hospital outcomes from medical records to perform group comparisons and exploratory multivariable logistic regression. This design allowed the team to identify potential associations between patient health metrics and the presence of the infection.

The primary findings indicated that patients with CDI had significantly lower body mass index, mean corpuscular volume, and serum albumin levels compared to those without the infection. Specifically, the body mass index difference was statistically significant with a P-value of 0.009, while the mean corpuscular volume showed a P-value of 0.014. Serum albumin levels also differed significantly between the two groups, with a P-value of 0.041.

Despite these significant univariate associations, the study found that none of the three variables remained independently associated with CDI in multivariable analysis. This distinction is crucial for clinical interpretation, as it indicates that while lower BMI, mean corpuscular volume, and serum albumin characterize patients with CDI, they do not independently predict infection after adjusting for other factors. Other hematological, inflammatory, hepatic, and renal parameters were generally comparable between groups.

Proton pump inhibitor, or PPI, exposure was common among patients with CDI, with nine of the ten infected patients having received PPIs for at least two weeks during their anti-tuberculosis treatment.

Seven patients with CDI improved during hospitalization, while two were transferred to higher-level hospitals. One patient died.

The study concludes that CDI represents an important diagnostic consideration for patients with rifampin-sensitive pulmonary tuberculosis who develop gastrointestinal symptoms during treatment. These findings highlight the importance of clinical vigilance and timely CDI testing in this population. While the study was limited to a single tertiary hospital in western China and involved a relatively small sample size, it provides valuable insights into the clinical profile of CDI in tuberculosis patients.

Subject of Research: Characterization of Clostridioides difficile infection in patients with rifampin-sensitive pulmonary tuberculosis

Article Title: Clostridioides difficile infection in rifampin-sensitive pulmonary tuberculosis: a retrospective comparative study

Article References: Liu, Y., Ren, C., Guo, Y., Jumahan, A., Yueriyeti, T., Yang, J., & Shi, C. (2026). Clostridioides difficile infection in rifampin-sensitive pulmonary tuberculosis: a retrospective comparative study. Frontiers in Cellular and Infection Microbiology, 16, Article 1926121. https://doi.org/10.3389/fcimb.2026.1926121

Image Credits: AI Generated

DOI: 10.3389/fcimb.2026.1926121

Keywords: Clostridioides difficile, pulmonary tuberculosis, retrospective study, serum albumin, body mass index, proton pump inhibitors, hospital-acquired infection, clinical outcomes, Clostridioides, difficile, infection, rifampin-sensitive