Pediatr Gastroenterol Hepatol Nutr.  2018 Jan;21(1):43-50. 10.5223/pghn.2018.21.1.43.

Clostridium difficile Infection at Diagnosis and during the Disease Course of Pediatric Inflammatory Bowel Disease

• Kim DH
• Cho JM
• Yang HR

• KMID: 2401772
• DOI: http://doi.org/10.5223/pghn.2018.21.1.43

Abstract

PURPOSE
Clostridium difficile colonization and infection are commonly associated with poor outcomes in patients with pediatric inflammatory bowel disease (PIBD). We aimed to investigate the prevalence of C. difficile colonization and infection at the time of diagnosis and to evaluate risk factors associated with the development of C. difficile infection during the course of PIBD treatment.
METHODS
We retrospectively enrolled a total of 59 children who were newly diagnosed with PIBD at the tertiary medical center. All patients underwent C. difficile toxin assays and cultures initially and at every follow-up during the disease course. Kaplan-Meier survival analysis and Cox regression test were used for statistical analysis.
RESULTS
Initial cultures for C. difficile were positive in 13 (22.0%) of 59 PIBD patients, whereas initial toxin assays were positive in 3 patients (5.1%). During treatment, C. difficile cultures converted to positive in 28 (47.5%) in addition to 13 patients who were initially culture-positive, and C. difficile toxins converted to positive in 13 (22.0%) in addition to 3 originally toxin-positive patients. Antibiotic usage alone was significantly associated with the development of C. difficile colonization (p=0.011), and the length of hospitalization was associated with the development of C. difficile infection (p=0.032).
CONCLUSION
C. difficile colonization and infection occur frequently during the disease course of PIBD. Antibiotic usage and longer hospital stay were significant risks factors for the conversion of C. difficile status in PIBD patients undergoing treatment.

Keyword

Clostridium difficile; Infection; Inflammatory bowel diseases; Child

MeSH Terms

Child
Clostridium difficile*
Clostridium*
Colon
Diagnosis*
Follow-Up Studies
Hospitalization
Humans
Inflammatory Bowel Diseases*
Length of Stay
Prevalence
Retrospective Studies
Risk Factors

Figure

• 

  Fig. 1 Survival curve for Clostridium difficile colonization with culture positivity during the disease course of inflammatory bowel disease in children with Crohn disease and those with ulcerative colitis, respectively. As C. difficile colonization was defined as the event for survival analysis, y axis of the graph indicates the ratio of C. difficile culture-negative children.

• 

  Fig. 2 Survival curve for Clostridium difficile infection with toxin and culture positivity during the disease course of inflammatory bowel disease in children with Crohn disease and those with ulcerative colitis, respectively. As C. difficile infection was defined as the event for survival analysis, y axis of the graph indicates the ratio of C. difficile toxin and culturenegative children.

• 

  Fig. 3 Relative hazard ratio graph (log scale) of Clostridium difficile infection according to total hospitalization period in children with inflammatory bowel disease.

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