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Microbial Shifts and Shorter Time to Bowel Resection Surgery Associated with C. difficile in Pediatric Crohn's

Jennifer Hellmann1, Heidi Andersen2, Lin Fei3

  • 1Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati, OH, USA.

Inflammatory Bowel Diseases
|November 15, 2019
PubMed

Insights

Clostridioides difficile infection in pediatric Crohn's disease patients significantly increases the risk of bowel resection surgery. This C. difficile positivity is linked to microbial shifts and reduced methionine biosynthesis, potentially driving surgical need.

Area of Science:

  • Gastroenterology
  • Microbiology
  • Pediatric Surgery

Background:

  • Clostridioides difficile infection (CDI) and colonization are prevalent in pediatric Crohn's disease (CD).
  • Understanding the link between CDI and surgical outcomes in pediatric CD is crucial.

Purpose of the Study:

  • To investigate the association between C. difficile positivity and bowel resection surgery in pediatric CD.
  • To characterize microbial shifts related to C. difficile carriage and surgery in these patients.

Main Methods:

  • Retrospective analysis of 75 pediatric CD patients for C. difficile carriage and surgery association.
  • Prospective study of 70 pediatric CD patients using C. difficile testing and shotgun metagenomic sequencing.
  • Microbiota analysis stratified by C. difficile carriage and surgical history.

Main Results:

  • Bowel resection surgery rates were 21% without C. difficile versus 67% with (P = 0.003).
  • Positive C. difficile testing within the first year of diagnosis showed a 4.4-fold increased hazard for first surgery (P = 0.00).
  • Significant microbial and metabolic pathway differences were observed, with depletion of Alistipes and Ruminococcus species and reduced methionine biosynthesis in patients with both C. difficile and prior surgery.

Conclusions:

  • Positive C. difficile testing in the first year of pediatric CD diagnosis is a strong predictor of earlier bowel resection surgery.
  • Microbiota alterations, including depletion of beneficial bacteria and impaired methionine biosynthesis, may underlie the increased surgical risk associated with C. difficile in pediatric CD.
Abstract

Keywords:
C. difficile infectionbowel resection surgeryfecal microbiomepediatric inflammatory bowel diseaseshotgun metagenomic sequencing

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