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Positivity of Stool Pathogen Sampling in Pediatric Inflammatory Bowel Disease Flares and Its Association With Disease
Pesah Melnik1, Niv Soffair1, Manar Matar1
1Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Petach Tikva.
Insights
Clostridium difficile infections, not Campylobacter jejuni, are linked to more severe outcomes in pediatric inflammatory bowel disease (IBD) flares. This finding highlights the importance of identifying specific enteric pathogens during IBD exacerbations.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Inflammatory Bowel Disease (IBD) Research
Background:
- Acute exacerbations of inflammatory bowel disease (IBD) in children can be complicated by enteric infections.
- Identifying specific pathogens during IBD flares is crucial for understanding disease severity and outcomes.
Purpose of the Study:
- To determine the frequency of Clostridium difficile toxin (CDT) and non-CDT enteric infections in pediatric IBD patients experiencing symptomatic flares.
- To compare the 1-year outcomes of pediatric IBD patients with CDT or other enteric infections versus those without.
Main Methods:
- Retrospective analysis of medical records for pediatric IBD patients with documented disease flares and stool sample collection.
- Matching of patients with positive enteric pathogen results to IBD patients with negative results for comparative outcome analysis.
- Evaluation of 1-year outcomes including disease flares, emergency room visits, and surgical interventions.
Main Results:
- Campylobacter jejuni and Clostridium difficile were the most common enteric infections identified.
- Pediatric IBD patients with positive Clostridium difficile toxin (CDT) results experienced significantly more disease flares and emergency room visits within 12 months compared to controls.
- A trend towards increased surgical interventions was observed in patients with CDT infections, though not statistically significant.
Conclusions:
- Clostridium difficile infection is associated with a more severe disease course in pediatric patients with inflammatory bowel disease flares.
- Campylobacter jejuni infections did not show a significant association with worse disease outcomes in this cohort.
- Targeted identification and management of Clostridium difficile are important during IBD exacerbations in children.
Objectives:
Acute exacerbations of inflammatory bowel disease (IBD) may involve enteric pathogen. We aimed to assess the frequency and outcomes of Clostridium difficille toxin (CDT) and non-CDT enteric infections in symptomatic pediatric patients with IBD.
Methods:
Patients' records were retrospectively searched for disease flares in which stool samples were collected for enteric pathogens. Each patient with a positive sample was matched with a patient with IBD flare and negative samples for analyzing 1-year outcomes following sampling.
Results:
A total of 618 pediatric patients with IBD [Crohn's disease, n = 439 (71%), mean age at diagnosis 13.0 ± 3.4 years, girls, n = 264 (42.7%)] had 1048 stool samples during the study period (2001-2018). Of 914 bacterial cultures, 40 (4.3%) were positive, 30 (75%) of which, positive for Campylobacter jejuni. Of 393 samples for CDT, 28 (7.1%) were positive while parasitic infection rate was 21/529 (3.9%).Overall, 19 positive C jejuni cases and 19 positive CDT cases with matching controls were examined. During 12 months of follow-up, the mean number of disease flares and emergency room visits was higher among patients with positive CDT (1.5 ± 1.4 vs 0.5 ± 0.9, P = 0.019, 1.3 ± 1.5 vs 0.4 ± 0.8, P = 0.05, respectively) with a numeric increase of surgical interventions (3 vs 0, P = 0.08). There were no significant differences in disease outcomes between patients with C jejuni infections and matched controls.
Conclusions:
C difficile and C jejuni are the most common enteric infections among pediatric patients with IBD but only clostridial infection was associated with a more severe disease course within 12 months.
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