title: Impact of Clostridium difficile infection on pediatric inflammatory bowel disease.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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; chi2 = 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.
authors.affiliation: Department of Pediatrics, University of Naples Federico II, Naples, Italy.
authors.forename: Filomena
authors.initials: F
authors.lastname: Pascarella
authors.forename: Massimo
authors.initials: M
authors.lastname: Martinelli
authors.forename: Erasmo
authors.initials: E
authors.lastname: Miele
authors.forename: Mariassunta
authors.initials: M
authors.lastname: Del Pezzo
authors.forename: Emanuela
authors.initials: E
authors.lastname: Roscetto
authors.forename: Annamaria
authors.initials: A
authors.lastname: Staiano
mesh_terms: D000293:Adolescent; D001427:Bacterial Toxins / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile; D004761:Enterocolitis, Pseudomembranous / Q000150:complications* / Q000175:diagnosis; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000382:microbiology*; D008297:Male; D012307:Risk Factors
chemical_list: D001427:Bacterial Toxins