P0794 Incidence of Clostridium Difficile Infection and enteric pathogens as a cause of Pediatric Inflammatory Bowel Disease flare up, retrospective study in the United Arab Emirates
Authors: Alsarhan A , Alshaibah K , tzivinikos C , Jasem R 
Published: January 2025

Abstract

Background
Pediatric patients with IBD are at increased risk of Clostridium difficile infection, which can trigger disease flare-ups. Since treatment for flares and infections differs, identifying the infection and causative microorganism is crucial. There is limited data on the frequency of CDI in pediatric IBD patients in our region. This study aims to assess its incidence and identify possible risk factors.

Methods
We conducted a retrospective cross-sectional study from October 2017 to May 2024, which included 144 encounters of pediatric IBD patients who presented with exacerbation of GI symptoms suggestive of flare up and underwent stool testing (PCR, C.difficile toxin detection (ELISA), and culture). We analyzed the association between categorical variables using the Chi-square test to identify the predictors of CDI. All tests were considered significant with a P-value &lt; 0.05.

Results
Stool PCR was positive in 45 encounters, with E.coli (11.8%) and C. difficile (10.4%)[a] being the most common pathogens. Other pathogens detected were Salmonella, Campylobacter, Norovirus, and Adenovirus. Patients with Crohn’s Disease had a higher rate of CDI than Ulcerative Colitis patients (17.2 vs 8.5%, P=0.151). Patients on biological therapies were significantly at a higher risk of developing CDI compared to patients who were not (17.9% vs 6.9%, P=0.042). We documented a higher rate of CDI in non-stricturing, non-fistulizing [b]CD patients. Additionally, we observed an increased rate of CDI in patients using azathioprine and corticosteroids, [c]though these findings were not statistically significant. Among patients hospitalized for flare-up symptoms, one-third were confirmed to have CDI.

Conclusion
CDI was common among pediatric IBD patients with flare-ups, particularly in those with Crohn's disease, non-stricturing, non-fistulizing[d] disease, on biologics, and those hospitalized for their symptoms. Early detection of CDI and other enteric pathogens is essential to guide appropriate management and prevent the harmful use of immunosuppressants during acute infections.

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