nach oben

Current Gastroenterology Reports

Erschienen in:

30.08.2023

Clostridioides difficile Infection in Pediatric Inflammatory Bowel Disease

verfasst von: Seth A. Reasoner, Maribeth R. Nicholson

Erschienen in: Current Gastroenterology Reports | Ausgabe 11/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Children with inflammatory bowel disease (IBD) are at increased risk of C. difficile infection (CDI) and experience worse outcomes associated with an infection. In this article, we review recent research on the incidence, diagnosis, complications, and treatment options for CDI in children with IBD.

Recent Findings

Children with IBD have an elevated incidence of CDI, but their CDI risk does not associate with established risk factors in adults with IBD. Existing testing methodologies are inadequate at differentiating CDI from C. difficile colonization in children with IBD. Fecal microbiota transplantation offers a durable cure for recurrent CDI.

Summary

CDI remains a frequent occurrence in children with IBD. Careful clinical monitoring should be used to diagnose CDI and patients with co-occurring IBD and CDI require careful surveillance for worse outcomes. Future research should explore the optimal diagnosis and treatment modalities in this unique patient population.

Smits WK, Lyras D, Lacy DB, Wilcox MH, Kuijper EJ. Clostridium difficile infection. Nat Rev Dis Primers. 2016;2:1–20.CrossRef

Czepiel J, Dróżdż M, Hanna Pituch EdJ, Kuijper WP, Mielimonka A, Goldman S, Wultańska D, Garlicki A, Biesiada G. Clostridium difficile infection: A review. Eur J Clin Microbiol Infect Dis. 2019;38:103–9.CrossRef

Hourigan SK, Chirumamilla SR, Ross T, et al. Clostridium difficile carriage and serum antitoxin responses in children with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:2744–52.PubMedCrossRef

Kim DH, Cho JM, Yang HR. Clostridium difficile infection at diagnosis and during the disease course of pediatric inflammatory bowel disease. Pediatr Gastroenterol Hepatol Nutr. 2018;21:43–50.PubMedPubMedCentralCrossRef

Edwards PT, Thurm CW, Hall M, et al. Clostridioides difficile Infection in Hospitalized Pediatric Patients: Comparisons of Epidemiology, Testing, and Treatment from 2013 to 2019. J Pediatr. 2023;252:111-116.e1.PubMedCrossRef

Pant C, Deshpande A, Gilroy R, Olyaee M, Donskey CJ. Rising incidence of clostridium difficile related discharges among hospitalized children in the United States. Infect Control Hosp Epidemiol. 2016;37:104–6.PubMedCrossRef

Chandrakumar A, Zohni H, El-Matary W. Clostridioides difficile Infection in Children with Inflammatory Bowel Disease. Inflamm Bowel Dis. 2020;26:1700–6.PubMedCrossRef

El-Matary W, Nugent Z, Yu BN, Lix LM, Targownik LE, Bernstein CN, Singh H. Trends and Predictors of Clostridium difficile Infection among Children: A Canadian Population-Based Study. J Pediatr. 2019;206:20–5.PubMedCrossRef

Hourigan SK, Oliva-Hemker M, Hutfless S. The Prevalence of Clostridium difficile Infection in Pediatric and Adult Patients with Inflammatory Bowel Disease. Dig Dis Sci. 2014;59:2222–7.PubMedCrossRef

10.

Nylund CM, Goudie A, Garza JM, Fairbrother G, Cohen MB. Clostridium difficile infection in hospitalized children in the United States. Arch Pediatr Adolesc Med. 2011;165:451–7.PubMedPubMedCentralCrossRef

11.

Issa M, Vijayapal A, Graham MB, et al. Impact of Clostridium difficile on Inflammatory Bowel Disease. Clin Gastroenterol Hepatol. 2007;5:345–51.PubMedCrossRef

12.

Balram B, Battat R, Al-Khoury A, D’Aoust J, Afif W, Bitton A, Lakatos PL, Bessissow T. Risk Factors Associated with Clostridium difficile infection in inflammatory bowel disease: A systematic review and meta-analysis. J Crohns Colitis. 2019;13:27–38.PubMedCrossRef

13.

Nguyen GC, Kaplan GG, Harris ML, Brant SR. A national survey of the prevalence and impact of Clostridium difficile infection among hospitalized inflammatory bowel disease patients. Am J Gastroenterol. 2008;103:1443–50.PubMedCrossRef

14.

Pascarella F, Martinelli M, Miele E, Del Pezzo M, Roscetto E, Staiano A. Impact of Clostridium difficile Infection on Pediatric Inflammatory Bowel Disease. J Pediatr. 2009;154:854–8.PubMedCrossRef

15.

Sandberg KC, Davis MM, Gebremariam A, Adler J. Disproportionate rise in clostridium difficile -associated hospitalizations among us youth with inflammatory bowel disease, 1997–2011. J Pediatr Gastroenterol Nutr. 2015;60:486–92.PubMedPubMedCentralCrossRef

16.••

Fang SB, Song YQ, Zhang CY, Wang LB. Risk factors for Clostridioides difficile infection in children and adolescents with inflammatory bowel disease: a systematic review and meta-analysis. World J Pediatrics. 2022;18:27–36. This systematic review included fourteen studies and over 17,000 pediatric and adolescent patients to evaluate risk factors for C. difficile in children with inflammatory bowel disease.CrossRef

17.

Martinelli M, Strisciuglio C, Veres G, et al. Clostridium difficile and pediatric inflammatory bowel disease: A prospective, comparative, multicenter, ESPGHAN study. Inflamm Bowel Dis. 2014;20:2219–25.PubMedCrossRef

18.

Banaszkiewicz A, Kowalska-Duplaga K, Pytrus T, Pituch H, Radzikowski A. Clostridium difficile infection in newly diagnosed pediatric patients with inflammatory bowel disease: Prevalence and risk factors. Inflamm Bowel Dis. 2012;18:844–8.PubMedCrossRef

19.

Hojsak I, Ferenc T, Bojanić K, Mišak Z, Močić Pavić A, Lukić-Grlić A, Kolaček S. Incidence of Clostridium difficile infection in children with inflammatory bowel disease compared to oncology and immunocompetent patients. Digestion. 2012;86:6–11.PubMedCrossRef

20.

Pant C, Anderson MP, Deshpande A, Altaf MA, Grunow JE, Atreja A, Sferra TJ. Health care burden of clostridium difficile infection in hospitalized children with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:1080–5.PubMedCrossRef

21.

Kelsen JR, Kim J, Latta D, Smathers S, McGowan KL, Zaoutis T, Mamula P, Baldassano RN. Recurrence rate of clostridium difficile infection in hospitalized pediatric patients with inflammatory bowel disease. Inflamm Bowel Dis. 2011;17:50–5.PubMedCrossRef

22.

Hellmann J, Andersen H, Fei L, et al. Microbial shifts and shorter time to bowel resection surgery associated with c. difficile in pediatric Crohn’s disease. Inflamm Bowel Dis. 2020;26:1212–21.PubMed

23.

Sehgal K, Yadav D, Khanna S. The interplay of Clostridioides difficile infection and inflammatory bowel disease. Therap Adv Gastroenterol. 2021. https://doi.org/10.1177/17562848211020285.CrossRefPubMedPubMedCentral

24.

Freedberg DE, LamousCrossed D, Sign-Smith ES, Lightdale JR, Jin Z, Yang YX, Abrams JA. Use of Acid Suppression Medication is Associated with Risk for C. difficile Infection in Infants and Children: A Population-based Study. Clin Infect Dis. 2015;61:912–7.PubMedPubMedCentralCrossRef

25.

Schneeweiss S, Korzenik J, Solomon DH, Canning C, Lee J, Bressler B. Infliximab and other immunomodulating drugs in patients with inflammatory bowel disease and the risk of serious bacterial infections. Aliment Pharmacol Ther. 2009;30:253–64.PubMedCrossRef

26.

Pérez-Cobas AE, Moya A, Gosalbes MJ, Latorre A. Colonization resistance of the gut microbiota against clostridium difficile. Antibiotics. 2015;4:337–57.PubMedPubMedCentralCrossRef

27.

Gevers D, Kugathasan S, Denson LA, et al. The treatment-naive microbiome in new-onset Crohn’s disease. Cell Host Microbe. 2014;15:382–92.PubMedPubMedCentralCrossRef

28.

Fitzgerald RS, Sanderson IR, Claesson MJ. Paediatric Inflammatory Bowel Disease and its Relationship with the Microbiome. Microb Ecol. 2021;82:833–44.PubMedPubMedCentralCrossRef

29.

Papa E, Docktor M, Smillie C, et al. Non-invasive mapping of the gastrointestinal microbiota identifies children with inflammatory bowel disease. PLoS ONE. 2012. https://doi.org/10.1371/journal.pone.0039242.CrossRefPubMedPubMedCentral

30.

Liu S, Zhao W, Lan P, Mou X. The microbiome in inflammatory bowel diseases: from pathogenesis to therapy. Protein Cell. 2021;12:331–45.PubMedCrossRef

31.

Shaw KA, Bertha M, Hofmekler T, et al. Dysbiosis, inflammation, and response to treatment: A longitudinal study of pediatric subjects with newly diagnosed inflammatory bowel disease. Genome Med. 2016. https://doi.org/10.1186/s13073-016-0331-y.CrossRefPubMedPubMedCentral

32.

Sokol H, Jegou S, McQuitty C, et al. Specificities of the intestinal microbiota in patients with inflammatory bowel disease and Clostridium difficile infection. Gut Microbes. 2018;9:55–60.PubMedCrossRef

33.

Yu S, Ge X, Xu H, Tan B, Tian B, Shi Y, Dai Y, Li Y, Hu S, Qian J. Gut microbiome and mycobiome in inflammatory bowel disease patients with Clostridioides difficile infection. Front Cell Infect Microbiol. 2023. https://doi.org/10.3389/fcimb.2023.1129043.CrossRefPubMedPubMedCentral

34.••

Bushman FD, Conrad M, Ren Y, et al. Multi-omic Analysis of the Interaction between Clostridioides difficile Infection and Pediatric Inflammatory Bowel Disease. Cell Host Microbe. 2020;28:422-433.e7. This study used longitudinal sampling and robust analysis of the microbiome and metabolome to identify differences in children with inflammatory bowel disease with and without C. difficile infection.PubMedPubMedCentralCrossRef

35.

Ejderhamn J, Rafter JJ, Strandvik B. Faecal bile acid excretion in children with inflammatory bowel disease. Gut. 1991;32:1346–51.PubMedPubMedCentralCrossRef

36.

Connors J, Dunn KA, Allott J, Bandsma R, Rashid M, Otley AR, Bielawski JP, Van Limbergen J. The relationship between fecal bile acids and microbiome community structure in pediatric Crohn’s disease. ISME J. 2020;14:702–13.PubMedCrossRef

37.

Jagt JZ, Verburgt CM, de Vries R, de Boer NKH, Benninga MA, de Jonge WJ, van Limbergen JE, de Meij TGJ. Faecal Metabolomics in Paediatric Inflammatory Bowel Disease: A Systematic Review. J Crohns Colitis. 2022;16:1777–90.PubMedPubMedCentralCrossRef

38.

Winston JA, Theriot CM. Impact of microbial derived secondary bile acids on colonization resistance against Clostridium difficile in the gastrointestinal tract. Anaerobe. 2016;41:44–50.PubMedPubMedCentralCrossRef

39.

Rotondo-Trivette S, Wang B, Gayer C, Parsana R, Luan Y, Sun F, Michail S. Decreased secondary faecal bile acids in children with ulcerative colitis and Clostridioides difficile infection. Aliment Pharmacol Ther. 2021;54:792–804.PubMedPubMedCentralCrossRef

40.

Kelly CR, Fischer M, Allegretti JR, Laplante K, Stewart DB, Limketkai BN, Stollman NH. ACG Clinical Guidelines: Prevention, Diagnosis, and Treatment of Clostridioides difficile Infections. Am J Gastroenterol. 2021;116:1124–47.PubMedCrossRef

41.

Khanna S, Shin A, Kelly CP. Management of Clostridium difficile Infection in Inflammatory Bowel Disease: Expert Review from the Clinical Practice Updates Committee of the AGA Institute. Clin Gastroenterol Hepatol. 2017;15:166–74.PubMedCrossRef

42.

Crobach MJT, Vernon JJ, Loo VG, Kong LY, Péchiné S, Wilcox MH, Kuijper EJ. Understanding clostridium difficile colonization. Clin Microbiol Rev. 2018. https://doi.org/10.1128/CMR.00021-17.CrossRefPubMedPubMedCentral

43.••

Parnell JM, Fazili I, Bloch SC, Lacy DB, Garcia-Lopez VA, Bernard R, Skaar EP, Edwards KM, Nicholson MR. Two-step Testing for Clostridioides Difficile is Inadequate in Differentiating Infection From Colonization in Children. J Pediatr Gastroenterol Nutr. 2021;72:378–83. This pivotal study demonstrated significant difficulties in differentiating C. difficile infection from colonization in children, including those with inflammatory bowel disease.PubMedPubMedCentralCrossRef

44.

Carroll KC, Mizusawa M. Laboratory Tests for the Diagnosis of Clostridium difficile. Clin Colon Rectal Surg. 2020;33:73–81.PubMedPubMedCentralCrossRef

45.

McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66:e1–48.PubMedPubMedCentralCrossRef

46.

Koo HL, Van JN, Zhao M, et al. Real-Time Polymerase Chain Reaction Detection of Asymptomatic Clostridium difficile Colonization and Rising C. difficile –Associated Disease Rates. Infect Control Hosp Epidemiol. 2014;35:667–73.PubMedCrossRef

47.

Polage CR, Gyorke CE, Kennedy MA, et al. Overdiagnosis of clostridium difficile infection in the molecular test era. JAMA Intern Med. 2015;175:1792–801.PubMedPubMedCentralCrossRef

48.

Novak-Weekley SM, Marlowe EM, Miller JM, Cumpio J, Nomura JH, Vance PH, Weissfeld A. Clostridium difficile testing in the clinical laboratory by use of multiple testing algorithms. J Clin Microbiol. 2010;48:889–93.PubMedPubMedCentralCrossRef

49.

Bernard R, Hammami MB, Arnold FW, Mcgrath B, Patel A, Wuerth B, Nicholson MR, Rao K, Micic D. Clostridioides difficile toxin is infrequently detected in inflammatory bowel disease and does not associate with clinical outcomes. Gut Pathog. 2022. https://doi.org/10.1186/s13099-022-00511-2.CrossRefPubMedPubMedCentral

50.

Wang Y, Atreja A, Wu X, Lashner BA, Brzezinski A, Shen B. Similar outcomes of IBD inpatients with clostridium difficile infection detected by ELISA or PCR assay. Dig Dis Sci. 2013;58:2308–13.PubMedCrossRef

51.

Chandrabos C, Chin K, Liu Y, Kohn N, Swaminath A, Sultan K. Clostridiodes difficile Treatment Guided by Polymerase Chain Reaction Stool Testing Does not Alter Outcomes for Patients With Inflammatory Bowel Disease. J Clin Med Res. 2021;13:572–4.PubMedPubMedCentralCrossRef

52.

Gupta A, Wash C, Wu Y, Sorrentino D, Nguyen VQ. Diagnostic Modality of Clostridioides difficile Infection Predicts Treatment Response and Outcomes in Inflammatory Bowel Disease. Dig Dis Sci. 2021;66:547–53.PubMedCrossRef

53.

Dalal RS, Allegretti JR. Diagnosis and management of Clostridioides difficile infection in patients with inflammatory bowel disease. Curr Opin Gastroenterol. 2021;37:336–43.PubMedPubMedCentralCrossRef

54.

Johnson S, Louie TJ, Gerding DN, Cornely OA, Chasan-Taber S, Fitts D, Gelone SP, Broom C, Davidson DM. Vancomycin, metronidazole, or tolevamer for clostridium difficile infection: Results from two multinational, randomized, controlled trials. Clin Infect Dis. 2014;59:345–54.PubMedCrossRef

55.

Parmar D, Dang R, Miranda-Katz M, Alabaster A, Greenhow TL. Risk factors for recurrent community-associated clostridiodes difficile infection in children. Pediatric Infectious Disease Journal. 2019;38:1073–8.PubMedCrossRef

56.

Baunwall SMD, Lee MM, Eriksen MK, Mullish BH, Marchesi JR, Dahlerup JF, Hvas CL. Faecal microbiota transplantation for recurrent Clostridioides difficile infection: An updated systematic review and meta-analysis. EClinicalMedicine. 2020. https://doi.org/10.1016/j.eclinm.2020.100642.CrossRefPubMedPubMedCentral

57.••

Nicholson MR, Alexander E, Ballal S, et al. Efficacy and Outcomes of Faecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection in Children with Inflammatory Bowel Disease. J Crohns Colitis. 2022;16:768–77. This is the largest study evaluating the use of fecal microbiota transplantation for the treatment of C. difficile infection in children with inflammatory bowel disease.PubMedCrossRef

58.

Allegretti JR, Kelly CR, Grinspan A, et al. Inflammatory Bowel Disease Outcomes following Fecal Microbiota Transplantation for Recurrent C. difficile Infection. Inflamm Bowel Dis. 2021;27:1371–8.PubMedCrossRef

Titel: Clostridioides difficile Infection in Pediatric Inflammatory Bowel Disease
verfasst von: Seth A. Reasoner
Maribeth R. Nicholson
Publikationsdatum: 30.08.2023
Verlag: Springer US
Erschienen in: Current Gastroenterology Reports / Ausgabe 11/2023
Print ISSN: 1522-8037
Elektronische ISSN: 1534-312X
DOI: https://doi.org/10.1007/s11894-023-00890-9

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

SGLT2-Inhibitoren und GLP-1-Rezeptoragonisten im Schlagabtausch

16.05.2024 DDG-Jahrestagung 2024 Kongressbericht

Wer hat die Nase vorn – SGLT2-Inhibitoren oder GLP-1-Rezeptoragonisten? Diese Frage diskutierten zwei Experten in einer Session auf dem diesjährigen Diabetes-Kongress.

Betalaktam-Allergie: praxisnahes Vorgehen beim Delabeling

16.05.2024 Pädiatrische Allergologie Nachrichten

Die große Mehrheit der vermeintlichen Penicillinallergien sind keine. Da das „Etikett“ Betalaktam-Allergie oft schon in der Kindheit erworben wird, kann ein frühzeitiges Delabeling lebenslange Vorteile bringen. Ein Team von Pädiaterinnen und Pädiatern aus Kanada stellt vor, wie sie dabei vorgehen.

Alphablocker schützt vor Miktionsproblemen nach der Biopsie

16.05.2024 alpha-1-Rezeptorantagonisten Nachrichten

Nach einer Prostatabiopsie treten häufig Probleme beim Wasserlassen auf. Ob sich das durch den periinterventionellen Einsatz von Alphablockern verhindern lässt, haben australische Mediziner im Zuge einer Metaanalyse untersucht.

Delir bei kritisch Kranken – Antipsychotika versus Placebo

16.05.2024 Delir nicht substanzbedingt Nachrichten

Um die Langzeitfolgen eines Delirs bei kritisch Kranken zu mildern, wird vielerorts auf eine Akuttherapie mit Antipsychotika gesetzt. Eine US-amerikanische Forschungsgruppe äußert jetzt erhebliche Vorbehalte gegen dieses Vorgehen. Denn es gibt neue Daten zum Langzeiteffekt von Haloperidol bzw. Ziprasidon versus Placebo.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 11/2023

Treatment of Cholestasis in Infants and Young Children

Treatment of Pediatric Eosinophilic Esophagitis: Traditional and Novel Therapies

Update on Cystic Fibrosis in Pediatric Patients

Esophageal Cancer: Overview, Risk Factors, and Reasons for the Rise

Point-of-Care Intestinal Ultrasound in Pediatric Inflammatory Bowel Disease