Pediatric patients with inflammatory bowel disease (IBD) are at increased risk of developing Clostridioides difficile infections (CDI), which could lead to treatment escalation later in life.
A team, led by Wael El-Matary, MD, University of Manitoba, Department of Pediatric Gastroenterology, examined the incidence and risk factors associated with CDI in pediatric patients with IBD in Manitoba, Canada.
The data was presented at the 16th Congress of the European Organization for Crohn’s and Colitis (ECCO).
Toxigene C difficile, is an anaerobic gram-positive spore-forming opportunistic pathogen associated with profuse diarrhea and gastroenteritis-associated mortality, particularly for pediatric patients with IBD.
In the longitudinal population-based cohort, the researchers examined data for all children and adolescents under the age of 17 diagnosed with IBD in Manitoba between 2011-2019. There were a total of 261 patients with IBD in the study, of whom 7.7% (n = 20) developed C difficile infection with an incidence of 5.04 cases per 1000 person-years.
The median age at diagnosis was 12.96 years.
The team confirmed C difficile infections based on the Triage C difficile immunoassay and polymerase chain reaction assay to detect the presence of toxigenic C difficile. They also used Fisher’s exact test to examine the relationship between categorical variables and Cox regression models to estimate the risk of CDI development in IBD patients.
For patients with ulcerative colitis, the incidence of CDI was 4.16 cases per 1000 person-years, while the incidence was 5.88 cases per 1000 person-years in patients with Crohn’s disease (P = 0.46).
Overall, pediatric patients with CDI had an increased risk of future exposure to systemic corticosteroids (HR 4.30; 95% CI 1.44-12.87) and biologics against tumor necrosis factor (TNF) (HR 3.37; 95% BI 1.13). –10.09) compared to individuals without CDI.
The overall recurrence rate of CDI in the pediatric IBD population was 25%.
“Our findings confirm that children with IBD are at high risk of developing CDI, which may predict a future escalation of IBD therapy,” the authors wrote.
ECCO . FMT data
In another abstract presented at ECCO, researchers found that fecal microbiota transplantation (FMT) was a viable option for IBD patients with CDI co-infection.
Fecal Microbiota Transplantation is a relatively new treatment method for refractory C difficile infections. For patients with inflammatory bowel disease, there is an increased risk of CDI co-infection than for the general population due to the use of immunosuppressive drugs and the dysbiosis of the bacteria in the colon.
There were 186 FMT requests to treat 176 rCDI patients between March 2016 and August 2019, including 26 patients with rCDI and IBD. In addition, 129 subjects, including 14 suffering from IBD, were treated with 143 FMTs for CDI with an 89.9% cure rate after a single FMT (n = 116).
However, FMT was not appropriate for 12 of the 26 IBD patients because these patients had C difficile carriage rather than active CDI infection.
Three patients suffered from rCDI with an active episode of IBD, while 1 patient developed a recurrence of CDI infection within 2 months (total cure rate 92%). The cure rate did not differ from CDI patients without IBD.
The study, “Closstridioides difficile infection in children with inflammatory bowel disease: a Canadian population-based study,” was published online by the European Crohn’s and Colitis Organization.