Clostridium Difficile Infection in Pediatric Inflammatory Bowel Disease Patients in the Era of Molecular Diagnostics and Advanced Therapeutics

Objective Increased prevalence of Clostridium difficile infection (CDI) in pediatric Inflammatory Bowel Disease (IBD) has been reported, primarily using stool toxin assay. Stool Polymerase Chain Reaction (PCR) testing for CDI has replaced toxin assay due to the higher sensitivity and specificity. No pediatric study has reviewed exclusive PCR testing to report CDI in IBD patients. Objective of this study is to analyze demographic and clinical features in IBD patienta？？s age 18 years and less, including Crohna？？s disease (CD) or ulcerative colitis (UC) who had CDI diagnosed by PCR at a tertiary childrena？？s hospital. Materials and Methods IBD patients with CDI were identified retrospectively from October, 2010 - June, 2014. Patientsa？？ demographics, IBD characteristics and treatment, treatment of CDI, response and recurrence were recorded. Comparisons between groups were analyzed using non-parametric tests. Results Forty three CD and 27 UC patients with CDI were identified. CDI presentation was abdominal cramping, diarrhea with or without bleeding. Higher percentage of CDI in CD 28/43 (65%) did not have gross bleeding compared to 11/27 (41%) UC (p= 0.05). Significantly higher proportion of CD versus UC patients was on Infliximab. Majority of patients (64/70; 91%) received metronidazole. Conclusions CDI should be considered while evaluating pediatric patients with IBD flare up. Absence of blood in stool does not rule out CDI. CD patients on infliximab had a significantly higher proportion of CDI in our study. Most patients responded to metronidazole in both groups. Future studies are needed to evaluate risk of CDI associated with biologic therapy