Impact of Clostridium difficile Infection on Pediatric Inflammatory Bowel Disease

Pascarella, Filomena; Martinelli, Massimo; Miele, Erasmo; Del Pezzo, Mariassunta; Roscetto, Emanuela; Staiano, Annamaria

doi:10.1016/j.jpeds.2008.12.039

« Previous Next »The Journal of Pediatrics
Volume 154, Issue 6 , Pages 854-858, June 2009

Impact of Clostridium difficile Infection on Pediatric Inflammatory Bowel Disease

Filomena Pascarella, MD
- Department of Pediatrics, University of Naples “Federico II,” Naples, Italy
Massimo Martinelli
- Department of Pediatrics, University of Naples “Federico II,” Naples, Italy
Erasmo Miele, MD
- Department of Pediatrics, University of Naples “Federico II,” Naples, Italy
Mariassunta Del Pezzo, MD
- Department of Cellular and Molecular Biology and Pathology “Luigi Califano”, University of Naples “Federico II,” Naples, Italy
Emanuela Roscetto, PhD
- Department of Cellular and Molecular Biology and Pathology “Luigi Califano”, University of Naples “Federico II,” Naples, Italy
Annamaria Staiano, MD
- Department of Pediatrics, University of Naples “Federico II,” Naples, Italy
- Reprint requests: Annamaria Staiano, MD, Department of Pediatrics, University of Naples “Federico II”, Via S Pansini 5, 80131 Naples, Italy

Received 25 August 2008; received in revised form 17 November 2008; accepted 18 December 2008. published online 23 February 2009.

Objectives

To determine the prevalence of and explore possible differences in the risk for and symptoms of Clostridium difficile infection between patients with and without inflammatory bowel disease (IBD).

Study design

Stool specimens from subjects with and without IBD were evaluated for the presence of C difficile toxins. Demographic information, diagnosis, anatomic location, disease activity, IBD therapy, hospitalizations, and antibiotic and proton pump inhibitor (PPI) exposures were recorded.

Results

A total of 193 specimens were collected from 81 patients with IBD and 112 patients without IBD. The prevalence of C difficile infection was significantly greater in the patients with IBD than in those without IBD (P = .004; χ² = 0.003; odds ratio = 3.3; 95% confidence interval = 1.5 to 7.6). In the patients with IBD, the prevalence of active disease was significantly greater in the C difficile--infected patients than in the uninfected patients (P < .0001). Colonic involvement was found in all patients with IBD. The specific type of IBD, IBD therapy, and antibiotic and PPI exposures that predisposed patients with IBD to C difficile infection were not identified, whereas hospitalization was significantly more frequent in the patients without IBD (P = .025).

Conclusions

Our findings indicate that in children, IBD is associated with an increased prevalence of C difficile infection. The specific risk factors reported in adults were not identified in these children, suggesting the possible involvement of other mechanisms for acquiring the pathogen.

Abbreviations: CD, Crohn's disease, CI, Confidence interval, IBD, Inflammatory bowel disease, LCAI, Lichtiger Colitis Activity Index, OR, Odds ratio, PCDAI, Pediatric Crohn's Disease Activity Index, PPI, Proton pump inhibitor, UC, Ulcerative colitis