Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland.
Eur J Clin Microbiol Infect Dis. 2010 Oct;29(10):1265-70. doi: 10.1007/s10096-010-0997-9. Epub 2010 Jun 26.
The prevalence of Clostridium difficile infection (CDI) in pediatric patients with inflammatory bowel disease (IBD) is still not sufficiently recognized. We assessed the prevalence of CDI and recurrences in outpatients with IBD. In addition, the influence of IBD therapy on CDI and antimicrobial susceptibility of the potentially causative C. difficile strains was assessed. This was a prospective, single-center, observational study. All specimens were obtained between January 2005 and January 2007 from the IBD outpatient service and screened for C. difficile and its toxins. C. difficile isolates were genotyped by PCR ribotyping. Diagnosis of Crohn's disease (CD) and ulcerative colitis (UC) was based on Porto criteria. Severity of disease was assessed using the Hyams scale (for Crohn's disease) and the Truelove-Witts scale (for ulcerative colitis). One hundred and forty-three fecal samples from 58 pediatric IBD patients (21 with Crohn's disease and 37 with ulcerative colitis) were screened. The risk of C. difficile infection was 60% and was independent of disease type (CD or UC) (χ2 = 2.5821, df = 3, p = 0.4606). About 17% of pediatric IBD patients experienced a recurrence of CDI. All C. difficile strains were susceptible to metronidazole, vancomycin and rifampin. A high prevalence of C. difficile infection and recurrences in pediatric outpatients with IBD was observed, independent of disease type. There was no significant correlation between C. difficile infection and IBD therapy. PCR ribotyping revealed C. difficile re-infection and relapses during episodes of IBD in pediatric outpatients.
艰难梭菌感染（CDI）在儿童炎症性肠病（IBD）患者中的流行仍未得到充分认识。我们评估了IBD 门诊患者中 CDI 和复发的发生率。此外，还评估了 IBD 治疗对 CDI 和潜在致病艰难梭菌菌株的抗菌药物敏感性的影响。这是一项前瞻性、单中心、观察性研究。所有标本均于 2005 年 1 月至 2007 年 1 月从 IBD 门诊服务中获得，并进行艰难梭菌及其毒素筛查。通过 PCR 核糖体分型对艰难梭菌分离株进行基因分型。克罗恩病（CD）和溃疡性结肠炎（UC）的诊断依据为 Porto 标准。采用 Hyams 量表（用于 CD）和 Truelove-Witts 量表（用于 UC）评估疾病严重程度。对 58 例儿科 IBD 患者（21 例 CD 和 37 例 UC）的 143 份粪便样本进行了筛查。艰难梭菌感染的风险为 60%，与疾病类型（CD 或 UC）无关（χ2 = 2.5821，df = 3，p = 0.4606）。约 17%的儿科 IBD 患者经历了 CDI 的复发。所有艰难梭菌菌株均对甲硝唑、万古霉素和利福平敏感。在儿科 IBD 门诊患者中观察到艰难梭菌感染和复发的高发生率，与疾病类型无关。艰难梭菌感染与 IBD 治疗之间没有显著相关性。PCR 核糖体分型显示，在儿科门诊患者的 IBD 发作期间，存在艰难梭菌再感染和复发。
