The incidence of Clostridium difficile infection in children with and without inflammatory bowel diseases: A single-center study in Taiwan from 2006 to 2019

Mu-Ming Chien; Mei-Hwei Chang; Kai-Chi Chang; Yen-Hsuan Ni; Jia-Feng Wu

doi:10.1016/j.jfma.2024.04.006

The incidence of Clostridium difficile infection in children with and without inflammatory bowel diseases: A single-center study in Taiwan from 2006 to 2019

J Formos Med Assoc. 2024 Apr 16:S0929-6646(24)00206-7. doi: 10.1016/j.jfma.2024.04.006. Online ahead of print.

Authors

Mu-Ming Chien¹, Mei-Hwei Chang², Kai-Chi Chang³, Yen-Hsuan Ni², Jia-Feng Wu⁴

Affiliations

¹ Department of Pediatrics, Taipei Medical University Hospital, Taipei City, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei City, Taiwan; Taipei Medical University Research Center for Digestive Medicine, Taipei Medical University, Taipei City, Taiwan; Department of Pediatrics, National Taiwan University Hospital, Taipei City, Taiwan.
² Department of Pediatrics, National Taiwan University Hospital, Taipei City, Taiwan; College of Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
³ Department of Pediatrics, National Taiwan University Hospital, Taipei City, Taiwan.
⁴ Department of Pediatrics, National Taiwan University Hospital, Taipei City, Taiwan; College of Medicine, National Taiwan University Hospital, Taipei City, Taiwan. Electronic address: wjf@ntu.edu.tw.

PMID: 38631957
DOI: 10.1016/j.jfma.2024.04.006

Abstract

Background: The incidence of Clostridium difficile infection (CDI) is increasing around the world, and patients with inflammatory bowel disease (IBD) have a higher risk of obtaining CDI. The data on the incidence rate of CDI in the Asian pediatric IBD population was lacking.

Methods: We retrospectively collected data from a tertiary medical center in Taipei, Taiwan. All patients aged 1-18 years old who visited the outpatient department or were admitted to our hospital between 2006 and 2019 were included. CDI was defined as positive stool C. difficile toxin or C. difficile culture results with appropriate antibiotic use within the range of 7 days prior or 14 days after the result.

Results: We compared the average annual incidence of CDI before and after 2013. The average incidence of community-acquired CDI (CA-CDI) increased from 0.063 to 0.564 cases per 1,000 visits, with a rate ratio (RR) of 8.82 (95% CI 5.74-14.38). In patients with IBD, the rate increased from 26.738 to 278.873 cases per 1,000 visits (RR=10.12, 95% CI: 4.57-29.02). The average incidence rate increased from 0.685 to 1.874 cases per 1,000 admissions in pediatric general patients (RR = 2.72, 95% CI 1.82-4.20) and from 14.706 to 62.500 cases per 1,000 admissions in pediatric IBD patients (RR = 3.77, 95% CI 0.71-93.53).

Conclusions: Both CA-CDI and healthcare facility-onset CDI (HO-CDI) were increasing substantially in the pediatric population over the past decade in Taiwan. Compared to the general pediatric population, pediatric IBD patients had a much higher incidence of CDI.

Keywords: Asia; Clostridium difficile; Inflammatory bowel disease; Pediatric; Taiwan.