Journal Article

Clostridium difficile and Pediatric Inflammatory Bowel Disease: A Prospective, Comparative, Multicenter, ESPGHAN Study

Veres, Gabor, Martinelli, Massimo, Pavic, Ana M., Levine, Arie, Strisciuglio, Caterina, Aloi, Marina, Turner, Dan, Staiano, Annamaria, Paerregaard, Anders, Miele, Erasmo, Martín-de-Carpi, Javier, Del Pezzo, Mariassunta

2014

Overview

Clostridium difficile infection is associated with pediatric inflammatory bowel disease (IBD) in several ways. We sought to investigate C. difficile infection in pediatric patients with IBD in comparison with a group of children with celiac disease and to evaluate IBD disease course of C. difficile infected patients.MethodsIn this prospective, comparative, multicenter study, 211 pediatric patients with IBD were enrolled from October 2010 to October 2011 and tested for the presence of C. difficile toxins A and B in their stools at 0, 6, and 12 months. During the same study period, stool specimens for C. difficile toxins analysis were collected from 112 children with celiac disease as controls.Results Clostridium difficile occurrence was significantly higher in patients with IBD compared with patients with celiac disease (7.5% versus 0.8%; P = 0.008). Clostridium difficile was associated with active disease in 71.4% of patients with IBD (P = 0.01). Colonic involvement was found in 85.7% of patients with C. difficile. Antibiotics, proton pump inhibitors, hospitalization, and IBD therapies were not associated with increased C. difficile detection. At 12 months, a higher number of C. difficile–positive patients at the enrollment started immunosuppressant/biological therapy compared with patients without C. difficile (P = 0.01). At 6 and 12 months, patients with C. difficile were more frequently in active disease than patients without C. difficile (P = 0.04; P = 0.08, respectively). Hospitalizations were higher at 6 months in C. difficile group (P = 0.05).ConclusionsIn conclusion, this study demonstrates that pediatric IBD is associated with increased C. difficile detection. Patients with C. difficile tend to have active colonic disease and a more severe disease course.

• Publisher: Oxford University Press
• Subject: Adolescent / Anti-Bacterial Agents - therapeutic use / Celiac disease / Celiac Disease - diagnosis / Celiac Disease - drug therapy / Celiac Disease - microbiology / Child / Child, Preschool / Clostridium difficile / Clostridium difficile - isolation & purification / Clostridium difficile - pathogenicity / Clostridium Infections - complications / Clostridium Infections - diagnosis / Clostridium Infections - mortality / Female / Follow-Up Studies / Humans / Inflammatory bowel disease / Inflammatory Bowel Diseases - diagnosis / Inflammatory Bowel Diseases - drug therapy / Inflammatory Bowel Diseases - microbiology / Male / Pediatrics / Prognosis / Prospective Studies / Proton Pump Inhibitors - therapeutic use / Toxins