Positivity of stool pathogen sampling in pediatric inflammatory bowel disease flares and its association with disease course

Objectives: Acute exacerbations of inflammatory bowel disease (IBD) may involve enteric pathogen. We aimed to assess the frequency and outcomes of Clostridium difficille toxin (CDT) and non-CDT enteric infections in symptomatic pediatric patients with IBD. Methods: Patients' records were retrospectively searched for disease flares in which stool samples were collected for enteric pathogens. Each patient with a positive sample was matched with a patient with IBD flare and negative samples for analyzing 1-year outcomes following sampling. Results: A total of 618 pediatric patients with IBD [Crohn's disease, n=439 (71%), mean age at diagnosis 13.0 3.4 years, girls, n=264 (42.7%)] had 1048 stool samples during the study period (2001-2018). Of 914 bacterial cultures, 40 (4.3%) were positive, 30 (75%) of which, positive for Campylobacter jejuni. Of 393 samples for CDT, 28 (7.1%) were positive while parasitic infection rate was 21/529 (3.9%). Overall, 19 positive C jejuni cases and 19 positive CDT cases with matching controls were examined. During 12 months of follow-up, the mean number of disease flares and emergency room visits was higher among patients with positive CDT (1.5 1.4 vs 0.5 0.9, P=0.019, 1.3 1.5 vs 0.4 0.8, P=0.05, respectively) with a numeric increase of surgical interventions (3 vs 0, P=0.08). There were no significant differences in disease outcomes between patients with C jejuni infections and matched controls. Conclusions: C difficile and C jejuni are the most common enteric infections among pediatric patients with IBD but only clostridial infection was associated with a more severe disease course within 12 months.