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Published on: December 8, 2014
Clostridium difficile infection and treatment in the pediatric inflammatory bowel disease population
Ethan Mezoff1, Elizabeth A Mann, Kim Ward Hart
1Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Insights
Clostridium difficile-associated disease (CDAD) is common in pediatric inflammatory bowel disease (IBD) patients. Initial antimicrobial treatment for CDAD often fails, with metronidazole and vancomycin showing similar efficacy.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Clostridium difficile infection (CDI) epidemiology is changing, with increased incidence and recognition of inflammatory bowel disease (IBD) patients at risk.
- The efficacy of standard antimicrobial therapies for CDI is increasingly questioned.
- Pediatric IBD populations represent a vulnerable group for CDI, necessitating further investigation into incidence and treatment outcomes.
Purpose of the Study:
- To determine the incidence of Clostridium difficile-associated disease (CDAD) in a pediatric IBD cohort.
- To evaluate the efficacy of different antimicrobial treatments for CDAD in this population.
- To identify factors influencing treatment success or recurrence of CDAD in pediatric IBD patients.
Main Methods:
- Retrospective review of a pediatric IBD database (ages ≤18 years) from August 2007 to December 2008.
- Identification of patients testing positive for C. difficile toxins A and/or B.
- Statistical analysis using chi-square, Fisher exact, and Student t tests to compare demographic and treatment variables.
Main Results:
- A total of 40 CDAD cases were identified in 29 out of 372 pediatric IBD patients, yielding an annualized incidence rate of 7.2%.
- Initial antimicrobial treatment success was achieved in 43% of cases; eventual success rates were similar for metronidazole (41%) and vancomycin (43%).
- No association was found between age, sex, IBD type, or IBD therapy with initial treatment outcome or recurrence, though anti-inflammatory therapy correlated with initial success.
Conclusions:
- CDAD occurs frequently in pediatric IBD patients, highlighting a significant clinical challenge.
- Metronidazole and vancomycin demonstrated comparable efficacy for CDAD treatment in this cohort.
- High rates of initial treatment failure suggest potential issues with antimicrobial resistance or increased IBD severity in carriers, emphasizing the need for careful management strategies.
Objective:
Recent changes in the epidemiology of Clostridium difficile infection include an increase in the incidence of C difficile-associated disease (CDAD) and the identification of patients with inflammatory bowel disease (IBD) as a group at risk. In addition, the effectiveness of antimicrobial therapies has been questioned. Our aim was to estimate the incidence of CDAD in a pediatric IBD population and review treatment efficacy.
Patients And Methods:
We identified patients ages 18 years or younger from our center's IBD database who tested positive for C difficile toxin A and/or B between August 1, 2007 and December 31, 2008. Demographic information and treatment details were recorded. Chi-square and Fisher exact tests were used to compare categorical variables and the Student t test was used for continuous variables.
Results:
From 372 pediatric patients with IBD, we identified 29 patients who experienced a total of 40 cases of CDAD. The annualized incidence rate of CDAD was 7.2%. Initial treatment was successful in 17 cases (43%). Eventual success was documented with metronidazole in 15 cases (41%), with vancomycin in 16 cases (43%), and with other agents or a combination of agents in 6 cases (16%). Age, sex, and IBD type were not associated with initial treatment outcome or recurrence. The choice of initial antimicrobial treatment was not associated with treatment outcome. The type of IBD therapy medication was not associated with the likelihood of CDAD recurrence, although the use of anti-inflammatory therapy was positively associated with initial antimicrobial treatment success.
Conclusions:
CDAD occurred frequently in our cohort of pediatric patients with IBD. Antimicrobial treatment success was achieved equally with either metronidazole or vancomycin. Initial treatment failed more than half of the time, regardless of medication choice. Apparent lack of antimicrobial efficacy in resolving symptoms may reflect resistant C difficile infection or increased IBD severity in a subset of patients who are C difficile carriers. Awareness of the potential for a high incidence of CDAD and frequent failure rate of initial therapy is important in the management of children with IBD.
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