P841 Implication of Clostridioides difficile in the diagnosis and evolution of patients with pediatric inflammatory bowel disease.
Palomino Pérez, L.M.(1)*;Delgado Fernández-Valdés, M.(2);Velasco Rodríguez-Belvís, M.(1);Cañedo Villarroya, E.(1);De la Mano Hernández, A.(1);Dominguez Ortega, G.(1);Martínez Pérez, J.(1);Martinez Navarro, G.(1);Martín Fernández, C.(1);Di Campli Zaghlul, M.(1);García Hernández, P.(1);Sánchez Llorente, P.(1);Muñoz Codoceo, R.A.(1);
(1)Hospital Infantil Universitario Niño Jesús, Gastroenterology and Nutrition, Madrid, Spain;(2)Universidad Autónoma de Madrid, Facultad de Medicina, Madrid, Spain;
Background
In the recent decades, the incidence of Clostridioides difficile (Cd) infection in children with inflammatory bowel disease (IBD) has increased, possibly due to underlying dysbiosis. The main objective of this study is to compare the prevalence of this infection in patients with IBD and without it, as well as secondarily to describe risk factors for Cd and its impact on the evolution of IBD.
Methods
Unicentric, observational and retrospective study of paediatric patients (<18 years old) undergoing Cd screening at the Hospital Infantil Universitario Niño Jesús in the last 5 years. Patients with IBD were those who met the Porto criteria. Statistical analysis was performed using SPSS.
Results
3,360 paediatric patients were included. Of the 150 patients whose screening was requested by the Digestive Section, 87 had IBD. There were no statistically significant differences in the prevalence of infection in patients with IBD compared to other patients (p=0,061).
According to the Paris Classification, no differences were found in relation to the prevalence of Cd infection, except for patients with growth impairment (G1), with a higher prevalence of infection compared to those without (G0) (33.3% vs. 13.9%) p<0.05. Regarding treatment, a higher prevalence of Cd infection was observed in patients receiving aminosalicylates monotherapy (42.9% vs. 13.4%) p<0.05 and in patients receiving NEE in monotherapy (60% vs. 15.8%) p<0.05. In contrast, a lower prevalence of Cd was observed in patients treated with azathioprine (with or without other therapies) compared to those not receiving azathioprine (10.3% vs. 26.2%) p<0.05. A lower prevalence of positives was also observed among those treated with biologics (with or without other therapies) (8% vs. 23.2%) p<0.05.
Patients with IBD in whom the test was positive required more frequent changes in their baseline treatment than those who had negative screening (72.2% vs. 14.9%, p<0.05).
Conclusion
Although it has not been demonstrated that Cd is more prevalent in patients with IBD, it does seem to condition the course of the disease, being patients in whom more treatment changes have been made. Given the complexity of the data related to infection rates in relation to the different treatments, further studies in pediatric patients with concomitant IBD and Cd are considered necessary to confirm such differences and explain the possible pathophysiology.