Lack of relationship between Clostridium difficile toxin and inflammatory bowel disease in children.

Conflicting reports have appeared concerning the role of Clostridium difficile toxin in chronic inflammatory bowel disease. Therefore, we prospectively evaluated the incidence of C. difficile toxin in 44 children with inflammatory bowel disease of variable clinical severity over a 1-year period. Only 3/128 stool specimens provided by these patients were found to be toxin-positive. These three stool specimens were from three different patients with Crohn's disease of moderate severity who had no recent hospitalization or antibiotic exposure. None received vancomycin therapy and their stools became toxin-negative over 3 weeks with no apparent change in the patients' clinical condition. No patient with severe disease or recent exposure to antibiotics or sulfasalazine was found to have toxin-positive stools. Routine screening for C. difficile toxin in children with inflammatory bowel disease appears unwarranted.