Clostridium difficile infection in Polish pediatric outpatients with inflammatory bowel disease

Abstract

The prevalence of Clostridium difficile infection (CDI) in pediatric patients with inflammatory bowel disease (IBD) is still not sufficiently recognized. We assessed the prevalence of CDI and recurrences in outpatients with IBD. In addition, the influence of IBD therapy on CDI and antimicrobial susceptibility of the potentially causative C. difficile strains was assessed. This was a prospective, single-center, observational study. All specimens were obtained between January 2005 and January 2007 from the IBD outpatient service and screened for C. difficile and its toxins. C. difficile isolates were genotyped by PCR ribotyping. Diagnosis of Crohn’s disease (CD) and ulcerative colitis (UC) was based on Porto criteria. Severity of disease was assessed using the Hyams scale (for Crohn’s disease) and the Truelove–Witts scale (for ulcerative colitis). One hundred and forty-three fecal samples from 58 pediatric IBD patients (21 with Crohn’s disease and 37 with ulcerative colitis) were screened. The risk of C. difficile infection was 60% and was independent of disease type (CD or UC) (χ2 = 2.5821, df = 3, p = 0.4606). About 17% of pediatric IBD patients experienced a recurrence of CDI. All C. difficile strains were susceptible to metronidazole, vancomycin and rifampin. A high prevalence of C. difficile infection and recurrences in pediatric outpatients with IBD was observed, independent of disease type. There was no significant correlation between C. difficile infection and IBD therapy. PCR ribotyping revealed C. difficile re-infection and relapses during episodes of IBD in pediatric outpatients.

Incidence of Clostridium difficile Infection in Children with Inflammatory Bowel Disease Compared to Oncology and Immunocompetent Patients

“…Our study confirmed the previously reported [2] positive correlation between immunosuppression and C. difficile infection, showing the highest incidence in patients with malignant tumors who were severely immunosuppressed. However, as previously published [11,12], in IBD patients therapy with immunosuppressive drugs had no influence on the incidence of C. difficile . The highest incidence in oncology patients can be explained by more severe immunosuppression compared to IBD patients, which may modify important elements of the innate or adaptive immunoresponse to bacteria [27].…”

“…In contrast to these results, several recently published reports [8,15,16,17,18] found a significantly increased incidence of C. difficile infection in patients with IBD, particularly in the pediatric age group, ranging from 16 to 69% [11,12,19,20]. Reasons for this different incidence are unclear [17], but some propose that fecal-oral ingestion of spores may be more common in children [12,21]. Secondly, and in relation to IBD, children are more likely to have colonic CD and extensive UC compared to adults [22,23].…”

“…Several studies have shown that both incidence and morbidity of C. difficile in adult IBD patients are significantly increased [8,9,10]. However, in pediatric patients with IBD the incidence has not been well established, although some studies indicate it could be higher compared to diseased adults [11,12]. …”

Molecular and Microbiological Characterization of Clostridium difficile Isolates from Single, Relapse, and Reinfection Cases

“…Etest strip and MIC value measurements were performed according to the manufacturer's instructions. Antibiotic resistance was defined as follows, in accordance with the interpretative criteria described in the manufacturer's package insert and previous reports (1,48): vancomycin, Ն32 mg/liter; metronidazole, Ն32 mg/liter; clindamycin, Ն 8 mg/liter; ceftriaxone, Ն 64 mg/liter; erythromycin, Ն8 mg/liter; and ciprofloxacin, Ն4 mg/liter.…”

Clostridium difficile prevalence rates in a large healthcare system stratified according to patient population, age, gender, and specimen consistency

“…Additional studies are needed in order to learn more about the protective benefit of stomach acid against this disease and, particularly, against spores. The incidence of C. difficile infection in inflammatory bowel disease (IBD) patients is increasing, but the differential diagnosis of C. difficile disease versus active IBD is very challenging, especially since the carriage rates for C. difficile in IBD patients is higher than in the healthy population [19]. For example, in a study by Clayton et al in 2009 [20], 8.2% of IBD patients were infected with C. difficile compared to a 1.0% rate in their healthy population.…”