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

Abstract

Aims: The aim of this study was to determine the incidence of Clostridium difficile infection in hospitalized children with inflammatory bowel disease (IBD) and to compare it to other immunosuppressed patients at risk (oncology patients) as well as to immunocompetent patients. Methods: We analyzed data from all hospitalized children who underwent stool detection of C. difficile toxins A and B (n = 757) in a 5.5-year study period. Results: The number of positive tests was significantly increased in the oncology group compared to the IBD group (12.45 vs. 6.02%, p = 0.03) and immunocompetent group (12.45 vs. 5.7%, p = 0.01). Patients who had C. difficile infection used antibiotics prior to the test more often than patients who did not (12.69 vs. 1.73%, p = 0.03). Pearson’s correlation was positive for C. difficile infection and both antibiotics and immunosuppressants, while no correlation was found regarding age and gender. There were no significant differences regarding either IBD diagnosis (Crohn’s disease vs. ulcerative colitis, p = 0.71) or treatment used for IBD (p = 0.53) and C. difficile infection. Conclusion: In our setting, the incidence of C. difficile infection among hospitalized children with active IBD was found to be low. Children at increased risk for C. difficile infection were oncology patients receiving immunosuppressants and antibiotics.

Novel Risk Factors for Recurrent Clostridium difficile Infection in Children

“…A recent study highlighted that pediatric oncology patients had the highest incidence of CDI as well as the highest increase in incidence over a 5 year period from 2006 through 2011. 26 Our study is the first to demonstrate that these patients are also at the highest risk of recurrent disease.…”

“…Also notable, the 2012 study that demonstrated increased rates of CDI in children with malignancy did not demonstrate the same increases in CDI in hospitalized patients with inflammatory bowel disease or immunocompetent hospitalized children, again suggesting that there is something unique about the risk of CDI in children with malignancy outside of hospital exposures. 26 Future studies should explore the degree and duration of medical encounters in patients with CDI to better address this important question.…”

Microbiota biodiversity in inflammatory bowel disease

“…In a Polish retrospective study, Mir et al have examined the rate of C. difficile infection (CDI) in 123 new pediatric IBD patients and overall prevalence was 8.1%, significantly lower than in Poland but much higher than in the general population [24]. Other studies have reported a low incidence of CDI in pediatric IBD [25,26], but all studies support testing for C. difficile in suspected cases of new onset or flare pediatric IBD, and new biomarkers have been identified to distinguish C. difficile colonization from diseases that need therapy [26]. …”

Risk factors for Clostridium difficile infection in pediatric inpatients: A meta-analysis and systematic review

“…22 In hospitalized pediatric patients, several antibiotic classes were independently associated with CDI. Specifically, carbapenems were identified as a significant risk factor by 2 studies, 23,24 while aminoglycosides and cephalosporins were identified by only 1 study. 24 Individual studies included in this systematic review demonstrated significant risks with use of carbapenems, aminoglycosides, and thrd-or fourth-generation cephalosporins (Supplemental Table 2 online).…”

“…Specifically, carbapenems were identified as a significant risk factor by 2 studies, 23,24 while aminoglycosides and cephalosporins were identified by only 1 study. 24 Individual studies included in this systematic review demonstrated significant risks with use of carbapenems, aminoglycosides, and thrd-or fourth-generation cephalosporins (Supplemental Table 2 online). However, none of the individual antibiotic classes were evaluated by at least 3 different studies and were therefore deemed ineligible for the meta-analysis.…”