PT  - JOURNAL ARTICLE
AU  - Machta, Joseph
AU  - Alexander, Eliza
AU  - Naik, Sandhia
TI  - OC49 C. Difficile in Paediatric IBD
AID  - 10.1136/flgastro-2024-bspghan.48
DP  - 2024 Jul 01
TA  - Frontline Gastroenterology
PG  - A36--A37
VI  - 15
IP  - Suppl 1
4099  - http://fg.bmj.com/content/15/Suppl_1/A36.2.short
4100  - http://fg.bmj.com/content/15/Suppl_1/A36.2.full
SO  - Frontline Gastroenterol2024 Jul 01; 15
AB  - Clostridioides difficile (C.Difficile) is a spore-forming, toxin-producing, Gram-positive anaerobe and one of the most common causes of hospital-acquired and antibiotic-associated infectious diarrhoea(1). The estimated asymptomatic carriage rate of C.Difficile is approximately 5% in adults and between 15–70% in infants(2). Patients with inflammatory bowel disease (IBD) are thought to have higher prevalence of C.Difficile colonisation and C.Difficile Associated Disease (CDAD) than the general population, with associated worse outcomes(3 4).We performed a service evaulation study to ascertain the prevalence of C.Difficile carriage and CDAD in the regional paediatric population, comparing rates in the paediatric IBD patient population versus other groups. The hypothesis being that the rate of C.Difficile carriage and associated disease are higher in the IBD population. The study was registered with the Trust Clinical Effectiveness unit as a service evaluation project and so ethical approval was not required.We performed retrospective analysis of all paediatric C.Difficile requests sent to the Microbiology laboratory at a major NHS Trust between 12th April 2020 to 6th November 2022. 601 samples were submitted, from the major paediatric hospital, peripheral centres, and general practice. 78.2%(n=470) tests included for analysis, from patients aged 1 to 15 years (mean 8.3 years). 21.8%(n=131) were not analysed due to being non-diarrhoeal stool, repeat samples, aged <1 year, or cancelled by requesting clinician.32.9% (n=155) samples were from patients with known IBD. 55.5% (n=86) ulcerative colitis (UC), 36.77%(n=57) Crohn’s Disease (CrD), 7.74%(n=12) IBD unclassified (IBDU). Samples were analysed for C.Difficile glutamate dehydrogenase (GDH) immunoassay, C.Difficile toxin A and B, and polymerase chain reaction (PCR) DNA extraction of C.Difficile toxigenic gene material. GDH positive: 7.74%(n=12) in IBD group vs. 20%(n=63) non-IBD.Toxigenic gene positive: 5.8%(n=9) in IBD group vs. 9.84%(n=31) non-IBD.C.Difficile toxin A/B: 1.29%(n=2) in IBD group vs. 3.17%(n=10) non-IBD. Both patients in IBD group received gold-standard treatment vs. 60%(n=6) in non-IBD group.A chi-square test of independence was performed to examine the statistical significance of rates of positive GDH, Toxigenic gene, and Toxin A/B between IBD and non-IBD groups. We found a statistically significant increase in GDH positivity in the non-IBD group (p=0.02), but the differences in Toxigenic gene and Toxin A/B testing were not statistically significant (p=0.22 and 0.19 respectively).Our findings demonstrate a lower rate of C.Difficile colonisation in the paediatric IBD group in our population, although there is no statistically significant difference in the rate of CDAD, contrary to studies demonstrating higher rates of colonisation and CDAD in IBD. Reasons for the lower rate of colonisation and the equivocal rates of CDAD could range from stringent implementation of antibiotic stewardship policies, or genetic and microbiomic variability in the East London population. However, our results also suggest over-representation of CDAD-affected paediatric IBD patients compared to the rate of asymptomatic carriage in this group, which should be borne in mind when counselling these patients on the sequelae of IBD and the risks of antibiotic treatment.ReferencesLeffler DA, Lamont JT. Clostridium difficile Infection. New England Journal of Medicine. 2015 Apr 16;372(16):1539–48.Czepiel J, Dróżdż M, Pituch H, Kuijper EJ, Perucki W, Mielimonka A, et al. Clostridium difficile infection: review. European Journal of Clinical Microbiology & Infectious Diseases. 2019 Jul 3;38(7):1211–21.Hourigan SK, Sears CL, Oliva-Hemker M. Clostridium difficile Infection in pediatric inflammatory bowel disease. Inflamm Bowel Dis. 2016 Apr;22(4):1020–5.Martinelli M, Strisciuglio C, Veres G, Paerregaard A, Pavic AM, Aloi M, et al. Clostridium difficile and pediatric inflammatory bowel disease. Inflamm Bowel Dis. 2014 Dec;20(12):2219–25.