title: Complicated Clostridium difficile colitis in children with cystic fibrosis: association with gastric acid suppression?
abstract: Patients with cystic fibrosis (CF) have several risk factors for Clostridium difficile colonization such as frequent hospitalization and exposure to a broad array of antibiotics utilized for the control, eradication, and prophylaxis of respiratory pathogens. However, despite this high rate of colonization, the occurrence of C. difficile infection (CDI) in CF is rare. We report three children with CF who presented with severe community-associated CDI. All three children had complicated courses and one died. These children were in good health without significant morbidities, and were not frequently hospitalized nor did they receive frequent antibiotic courses. The occurrence of 3 severe cases within a 15-month period prompted us to report these cases and review the literature in regard to CDI. We reviewed the CF GI tract as possible risk factors for a high rate of C. difficile colonization in individuals with CF. Since a high percentage of individuals with CF are on gastric acid blocking agents, we also focused on gastric acid suppression as a potential risk factor for CDI.
authors.affiliation: University of Arkansas Medical Sciences, Department of Pediatrics, Pediatric Pulmonology, Arkansas Children's Hospital, United States. Electronic address: comgulnur@uams.edu.
authors.forename: G
authors.initials: G
authors.lastname: Com
authors.affiliation: University of Arkansas Medical Sciences, Department of Pathology, United States.
authors.forename: N
authors.initials: N
authors.lastname: Cetin
authors.affiliation: University of Arkansas Medical Sciences, College of Pharmacy, Department of Pharmacy Practice, United States; College of Medicine, Department of Pediatrics, Division of Pharmacology/Toxicology, United States.
authors.forename: C E
authors.initials: CE
authors.lastname: O'Brien
mesh_terms: D000293:Adolescent; D000863:Antacids / Q000009:adverse effects; D001706:Biopsy; D002648:Child; D016360:Clostridioides difficile / Q000254:growth & development*; D003106:Colon / Q000382:microbiology / Q000473:pathology; D003550:Cystic Fibrosis / Q000453:epidemiology / Q000382:microbiology*; D004761:Enterocolitis, Pseudomembranous / Q000139:chemically induced* / Q000453:epidemiology / Q000382:microbiology*; D064098:Esomeprazole / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D006801:Humans; D007223:Infant; D008297:Male; D008532:Megacolon, Toxic / Q000139:chemically induced / Q000453:epidemiology / Q000382:microbiology; D054328:Proton Pump Inhibitors / Q000009:adverse effects; D012307:Risk Factors
chemical_list: D000863:Antacids; D054328:Proton Pump Inhibitors; D064098:Esomeprazole
keywords: Acid blockers; Clostridium difficile; Cystic fibrosis; Diarrhea; Proton pump inhibitors