Abstract
Clostridium difficile Infection in Pediatric Inflammatory Bowel Disease Patients in the Era of Molecular Diagnostics and Advanced Therapeutics
Highlights
Clostridium difficile is gram-positive, cytotoxin producing anaerobic bacterium that may cause colonization or infection in the human host
One study in the literature did suggest that mortality rates were similar between Inflammatory Bowel Disease (IBD) patients treated with infliximab versus those who were treated with other treatment modalities (11)
One adult study concluded no increased rate of serious bacterial infection in IBD patients on biologic therapy, including Clostridium difficile infection (CDI), the risk of CDI was increased by three times with corticosteroid use (14)
Summary
Clostridium difficile is gram-positive, cytotoxin producing anaerobic bacterium that may cause colonization or infection in the human host. An increased prevalence of Clostridium difficile infection (CDI) in pediatric Inflammatory Bowel Disease (IBD) has been reported in various studies (1-3), primarily diagnosed by stool toxin assay (1, 4). Some risk factors for CDI have been reported consistently in adult IBD study including recent antibiotic use and recurrent hospitalizations (5), there are no consistent risk factors reported in pediatric studies. Report from the Centers for Disease Control and Prevention conclude that patients with no previously documented risk factors are at increasing risk of CDI with higher morbidity and mortality (6). All pediatric studies far reported in the literature are based on detection of stool toxins some of them have included cases diagnosed by both toxin and Polymerase Chain Reaction (PCR). No study has exclusively reviewed the use of the PCR technique to detect pediatric CDI in IBD patients. Our primary aim was to analyze demographic and clinical features of CDI in IBD patients aged ≤18 years, including Crohn’s disease (CD) and Ulcerative colitis (UC), at a tertiary children’s hospital in Detroit, MI
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