Incidence of Clostridium difficile infection and enteric pathogens in children with inflammatory bowel disease presenting with disease exacerbation.

OBJECTIVE

Pediatric patients with inflammatory bowel disease (IBD) are at increased risk of gastrointestinal infections including Clostridioides difficile infection (CDI), which can trigger disease exacerbations. Since treatment for disease flares and infections differs, identifying the infection and causative microorganisms is crucial. There is limited data on the frequency of CDI in pediatric patients with IBD in our region. This study aimed to determine the incidence of CDI and other enteric infections in pediatric patients with IBD presenting with symptoms suggestive of a flare, and to identify potential predictors of CDI.

METHODS

We conducted a retrospective study from 2017 to 2024, including pediatric patients with inflammatory bowel disease who presented with exacerbation of gastrointestinal symptoms suggestive of a flare-up and underwent stool testing. Demographic and clinical data, including IBD type, treatment regimens, and hospitalization status, were collected. Stool samples were analyzed for infectious pathogens. We analyzed the association between categorical variables using the Chi-square test to identify predictors of Clostridioides difficile infection (CDI). Statistical significance was set at a P-value <0.05.

RESULTS

Stool testing was performed in 144 encounters, of which 47 (32.6%) were positive for infectious pathogens. The most commonly identified organisms were Clostridioides difficile (11.8%) and E.coli (11.8%). Patients with Crohn's disease (CrD) had a higher rate of Clostridioides difficile infection (CDI) compared to those with ulcerative colitis (UC) (17.2% vs. 8.5%). Patients receiving biological therapies were at significantly higher risk of developing CDI compared to those not on biological therapy (17.9% vs. 6.9%, P = 0.042). Among patients hospitalized for flare-up symptoms, one-third were confirmed to have CDI.

CONCLUSION

Overall, stool testing was positive in over 30% of cases, CDI and E. coli were the most common identified infections in pediatric patients with IBD presenting with exacerbating symptoms, highlighting the significance of routine pathogen testing, in patients presenting with symptoms of suggestive of flare. CDI was particularly more prevalent among patients with Crohn's disease, those receiving biological therapy, and those hospitalized for their symptoms. Additionally, our findings highlighted the limited utility of traditional stool culture in detecting enteric infections.