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Clostridioides difficile Infection in Children With Inflammatory Bowel Disease
Abin Chandrakumar1,2, Hussein Zohni2, Wael El-Matary2,3,4
1Clinical Research Unit, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.
Insights
Children with inflammatory bowel disease (IBD) face a high risk of Clostridioides difficile infection (CDI). This infection is linked to increased use of corticosteroids and anti-TNF biologics, potentially escalating IBD treatment.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Immunology
Background:
- Investigating Clostridioides difficile infection (CDI) incidence and risk factors in pediatric inflammatory bowel disease (IBD) patients.
- Focus on a population-based cohort in Manitoba, Canada, from 2011-2019.
Purpose of the Study:
- To determine the incidence and identify risk factors for CDI in children with IBD.
- To assess the association between CDI and subsequent IBD treatment escalation.
Main Methods:
- Longitudinal population-based cohort study of children (<17 years) diagnosed with IBD.
- CDI diagnosis confirmed via immunoassay and PCR.
- Statistical analysis included Fisher exact test and Cox regression.
Main Results:
- 20 out of 261 (7.7%) pediatric IBD patients developed CDI, with an incidence of 5.04 per 1000 person-years.
- CDI was associated with increased exposure to systemic corticosteroids (aHR 4.38) and anti-TNF biologics (aHR 3.31).
- The recurrence rate of CDI in this cohort was 25%.
Conclusions:
- Children with IBD are at significant risk for developing CDI.
- CDI occurrence may indicate a need for intensified IBD therapy.
- Early identification and management of CDI are crucial in pediatric IBD care.
Background:
The study's objective was to investigate the incidence and risk factors associated with Clostridioides difficile (previously known as Clostridium) infection (CDI) in children with inflammatory bowel disease (IBD) in the province of Manitoba.
Methods:
Our longitudinal population-based cohort was comprised of all children and young adults aged <17 years diagnosed with IBD in the Canadian province of Manitoba between 2011 and 2019. The diagnosis of CDI was confirmed based on the Triage C. difficile immunoassay and polymerase chain reaction assay to detect the presence of toxigenic C. difficile. The Fisher exact test was used to examine the relationship between categorical variables. A Cox regression model was used to estimate the risk of CDI development in IBD patients.
Results:
Among 261 children with IBD, 20 (7.7%) developed CDI with an incidence rate of 5.04 cases per 1000 person-years, and the median age at diagnosis (interquartile range) was 12.96 (9.33-15.81) years. The incidence rates of CDI among UC and CD patients were 4.16 cases per 1000 person-years and 5.88 cases per 1000 person-years, respectively (P = 0.46). Compared with children without CDI, those who had CDI were at increased risk of future exposure to systemic corticosteroids (adjusted hazard ratio [aHR], 4.38; 95% confidence interval [CI], 1.46-13.10) and anti-tumor necrosis factor (anti-TNF) biologics (aHR, 3.31; 95% CI, 1.11-9.90). The recurrence rate of CDI in our pediatric IBD population was 25%.
Conclusions:
Our findings confirm that children with IBD are at high risk of developing CDI, which may predict future escalation of IBD therapy.
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