From the SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.
the Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.
J Pediatr Gastroenterol Nutr. 2022 Aug 1;75(2):173-180. doi: 10.1097/MPG.0000000000003489. Epub 2022 Jun 7.
Several studies have demonstrated higher rates of Clostridioides difficile infection (CDI) in adults with inflammatory bowel disease (IBD). We conducted a population-based study comparing the risk of hospitalization with CDI in children with and without IBD.
Using health administrative data and validated algorithms, we identified all children (<16 years) diagnosed with IBD in 5 Canadian provinces, then age and sex matched to 5 children without IBD. Province-specific 5-year incidence rates of hospitalization with CDI were pooled and generalized linear mixed-effects models were used to estimate the crude incidence rate ratio (IRR) comparing (1) children with and without IBD and (2) children with Crohn disease and ulcerative colitis. Hazard ratios (HR) from Cox proportional hazards models adjusting for age, sex, rural/urban household, and income were pooled using fixed-effects models.
The incidence rate of CDI identified during hospitalization was 49.06 [95% confidence interval (CI), 39.40-61.08] per 10,000 person-years (PY) in 3593 children with IBD compared to 0.39 (95% CI, 0.13-1.21) per 10,000 PY in 16,284 children without IBD (crude IRR, 133.4, 95% CI, 42.1-422.7; adjusted HR, 68.2, 95% CI, 24.4-190.4). CDI was identified less often in children with Crohn disease than ulcerative colitis (crude IRR, 0.51, 95% CI, 0.32-0.82; adjusted HR, 0.69, 95% CI, 0.46-1.05).
Children with IBD have a markedly higher incidence of CDI identified during a hospitalization relative to children without IBD. Consequently, symptomatic children with IBD who are hospitalized should be screened for CDI.
多项研究表明，炎症性肠病（IBD）患者中艰难梭菌感染（CDI）的发生率更高。我们进行了一项基于人群的研究，比较了患有和不患有 IBD 的儿童因 CDI 住院的风险。
使用健康管理数据和经过验证的算法，我们在加拿大的 5 个省份确定了所有被诊断患有 IBD 的儿童（<16 岁），然后按照年龄和性别与 5 名没有 IBD 的儿童相匹配。汇总了省级特定的 5 年 CDI 住院发生率，并使用广义线性混合效应模型估计了（1）患有和不患有 IBD 的儿童之间以及（2）患有克罗恩病和溃疡性结肠炎的儿童之间的住院 CDI 粗发病率比值（IRR）。使用固定效应模型对年龄、性别、农村/城市家庭和收入进行调整的 Cox 比例风险模型的危险比（HR）进行了汇总。
在 3593 名患有 IBD 的儿童中，有 49.06 [95%置信区间（CI），39.40-61.08]例 CDI 是在住院期间确诊的，而在 16284 名没有 IBD 的儿童中，有 0.39 [95%CI，0.13-1.21]例 CDI 是在住院期间确诊的（粗发病率比，133.4，95%CI，42.1-422.7；调整后的 HR，68.2，95%CI，24.4-190.4）。与溃疡性结肠炎相比，患有克罗恩病的儿童中 CDI 的检出率较低（粗发病率比，0.51，95%CI，0.32-0.82；调整后的 HR，0.69，95%CI，0.46-1.05）。
与没有 IBD 的儿童相比，患有 IBD 的儿童在住院期间 CDI 的发病率明显更高。因此，因 IBD 住院的有症状儿童应进行 CDI 筛查。
