Hospitalization with Clostridioides difficile in Pediatric Inflammatory Bowel Disease: A Population-Based Study

M. Ellen Kuenzig; Eric I. Benchimol; Charles N. Bernstein; Alain Bitton; Matthew W. Carroll; Anne M. Griffiths; Gilaad G. Kaplan; Geoffrey C. Nguyen; Anthony R. Otley; Therese A. Stukel; Trevor J.B. Dummer; Wael El-Matary; Kevan Jacobson; Jennifer L. Jones; Lisa M. Lix; David R. Mack; Sanjay K. Murthy; Juan Nicolás Peña-Sánchez; Laura E. Targownik; Stephen G. Fung; Sarah Spruin; Stephanie Coward; Yunsong Cui; Christopher Filliter; Zoann Nugent; Shabnaz Siddiq; Harminder Singh

doi:10.1097/MPG.0000000000003489

Hospitalization with Clostridioides difficile in Pediatric Inflammatory Bowel Disease: A Population-Based Study

M. Ellen Kuenzig, Eric I. Benchimol, Charles N. Bernstein, Alain Bitton, Matthew W. Carroll, Anne M. Griffiths, Gilaad G. Kaplan, Geoffrey C. Nguyen, Anthony R. Otley, Therese A. Stukel, Trevor J.B. Dummer, Wael El-Matary, Kevan Jacobson, Jennifer L. Jones, Lisa M. Lix, David R. Mack, Sanjay K. Murthy, Juan Nicolás Peña-Sánchez, Laura E. Targownik, Stephen G. FungSarah Spruin, Stephanie Coward, Yunsong Cui, Christopher Filliter, Zoann Nugent, Shabnaz Siddiq, Harminder Singh

Medicine

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Objectives: 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. Methods: 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. Results: 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). Conclusions: 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.

Original language	English
Pages (from-to)	173-180
Number of pages	8
Journal	Journal of Pediatric Gastroenterology and Nutrition
Volume	75
Issue number	2
DOIs	https://doi.org/10.1097/MPG.0000000000003489
Publication status	Published - Aug 1 2022

Bibliographical note

Funding Information:
E.I.B. has acted as a legal consultant for Hoffman La-Roche Limited and Peabody & Arnold LLP for matters unrelated to a medication used to treat inflammatory bowel disease or C. difficile infection. He has also acted as a consultant for McKesson Canada. G.G.K. has received honoraria for speaking or consultancy from Abbvie, Janssen, Pfizer, Amgen, and Takeda. He has received research support from Ferring, Janssen, Abbvie, GlaxoSmith Kline, Merck, and Shire. He shares ownership of a patent: TREATMENT OF INFLAMMATORY DISORDERS, AUTOIMMUNE DISEASE, AND PBC. UTI Limited Partnership, assignee. Patent 62/ 555,397. A.R.O. has been on advisory boards of AbbVie Canada, Janssen Canada, and Nestle. He has received unrestricted educational grants from AbbVie Canada and Janssen Canada. His site is involved with clinical trials for AbbVie, Pfizer, Takeda, Eli Lily, and Celgene. A.M.G. has been a consultant for Abbvie, Amgen, BristolMyersSquibb, Janssen, Lilly, Pfizer, Roche; has received speaker fees from Abbvie, Janssen, Nestle, and investigator-initiated grant support from Abbvie. L.E.T. has received investigator initiated funding from Janssen Canada, and served on advisory boards for AbbVie Canada, Sandoz Canada, Takeda Canada, Merck Canada, Pfizer Canada, Janssen Canada, and Roche Canada. C.N.B. has been on the advisory boards of Abbvie Canada, Amgen Canada, Bristol Myers Squibb Canada, Janssen Canada, Pfizer Canada, Sandoz Canada, Takeda Canada, Roche Canada, and consulted to Takeda and Mylan Pharmaceuticals. He has been on the speaker’s bureau for Abbvie Canada, Janssen Canada, Takeda Canada and Medtronic Canada. He has received unrestricted educational grants from Abbvie Canada, Janssen Canada, Pfizer Canada, and Takeda Canada and has done contract research with Abbvie, Janssen, Pfizer, Celgene, Boeringher Ingelheim, and Roche. K.J. has been on Advisory boards of Abbvie Canada, Janssen Canada, Merck Canada, and Mylan Pharmaceuticals. He has been on the speaker’s bureau of Abbvie Canada and Janssen Canada. He has received investigator-initiated research support from Abbvie Canada and Janssen Canada. W.E.M. has received honoraria for speaking or consultancy from Abbvie and MERCK. H.S. has consulted to Amgen Canada, Bristol-Myers Squibb Canada, Sandoz Canada, Roche Canada, Takeda Canada, and Guardant Health. The remaining authors report no conflicts of interest.

Funding Information:
Sources of Funding: E.K. was supported by a Post-Doctoral Fellowship Award from the Canadian Institutes of Health Research (CIHR), Canadian Association of Gastroenterology (CAG), and Crohn’s and Colitis Canada and a Mitacs Elevate Post-Doctoral Fellowship. D.R.M. receives partial funding through a University of Ottawa Faculty of Medicine Distinguished Clinical Research Chair in Pediatric Inflammatory Bowel Disease Award. L.M.L. was supported by a Tier I Canada Research Chair. E.I.B. was supported by a New Investigator Award from the CIHR, CAG, and Crohn’s and Colitis Canada. E.I.B. was also supported by the Career Enhancement Program of the Canadian Child Health Clinician Scientist Program. Data availability statement: The data set from this study is held securely in coded form at ICES. While legal data sharing agreements between ICES and data providers (e.g., healthcare organizations and government) prohibit ICES from making the data set publicly available, access may be granted to those who meet prespecified criteria for confidential access, available at www.ices.on.ca/DAS (email: das@ices.on.ca ). The full data set creation plan and underlying analytic code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are, therefore, either inaccessible or may require modification. This work was supported by a Grant-in-Aid of Research from Crohn’s and Colitis Canada, a Foundation Grant from the Canadian Institutes of Health Research (grant number 201409FDN-333131-FDN-CECC-164898), and a Canadian Institutes of Health Research Project Scheme Grant (Reference number PJT-162393). This study was supported by the ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Parts of this material are based on data and information compiled and provided by MOH and CIHI. Parts of this material are based on data and information provided by Alberta Health Services, Manitoba Health, Health Data Nova Scotia, and Régie de l’assurance maladie du Québec. The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.

ASJC Scopus Subject Areas

Pediatrics, Perinatology, and Child Health
Gastroenterology

PubMed: MeSH publication types

Journal Article
Research Support, Non-U.S. Gov't

Access to Document

10.1097/MPG.0000000000003489

Cite this

Kuenzig, M. E., Benchimol, E. I., Bernstein, C. N., Bitton, A., Carroll, M. W., Griffiths, A. M., Kaplan, G. G., Nguyen, G. C., Otley, A. R., Stukel, T. A., Dummer, T. J. B., El-Matary, W., Jacobson, K., Jones, J. L., Lix, L. M., Mack, D. R., Murthy, S. K., Peña-Sánchez, J. N., Targownik, L. E., ... Singh, H. (2022). Hospitalization with Clostridioides difficile in Pediatric Inflammatory Bowel Disease: A Population-Based Study. Journal of Pediatric Gastroenterology and Nutrition, 75(2), 173-180. https://doi.org/10.1097/MPG.0000000000003489

Kuenzig, ME, Benchimol, EI, Bernstein, CN, Bitton, A, Carroll, MW, Griffiths, AM, Kaplan, GG, Nguyen, GC, Otley, AR, Stukel, TA, Dummer, TJB, El-Matary, W, Jacobson, K, Jones, JL, Lix, LM, Mack, DR, Murthy, SK, Peña-Sánchez, JN, Targownik, LE, Fung, SG, Spruin, S, Coward, S, Cui, Y, Filliter, C, Nugent, Z, Siddiq, S & Singh, H 2022, 'Hospitalization with Clostridioides difficile in Pediatric Inflammatory Bowel Disease: A Population-Based Study', Journal of Pediatric Gastroenterology and Nutrition, vol. 75, no. 2, pp. 173-180. https://doi.org/10.1097/MPG.0000000000003489

@article{2eeda17d82d34e94a7411816e08bc421,

title = "Hospitalization with Clostridioides difficile in Pediatric Inflammatory Bowel Disease: A Population-Based Study",

abstract = "Objectives: 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. Methods: 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. Results: 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). Conclusions: 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.",

author = "Kuenzig, {M. Ellen} and Benchimol, {Eric I.} and Bernstein, {Charles N.} and Alain Bitton and Carroll, {Matthew W.} and Griffiths, {Anne M.} and Kaplan, {Gilaad G.} and Nguyen, {Geoffrey C.} and Otley, {Anthony R.} and Stukel, {Therese A.} and Dummer, {Trevor J.B.} and Wael El-Matary and Kevan Jacobson and Jones, {Jennifer L.} and Lix, {Lisa M.} and Mack, {David R.} and Murthy, {Sanjay K.} and Pe{\~n}a-S{\'a}nchez, {Juan Nicol{\'a}s} and Targownik, {Laura E.} and Fung, {Stephen G.} and Sarah Spruin and Stephanie Coward and Yunsong Cui and Christopher Filliter and Zoann Nugent and Shabnaz Siddiq and Harminder Singh",

note = "Funding Information: E.I.B. has acted as a legal consultant for Hoffman La-Roche Limited and Peabody & Arnold LLP for matters unrelated to a medication used to treat inflammatory bowel disease or C. difficile infection. He has also acted as a consultant for McKesson Canada. G.G.K. has received honoraria for speaking or consultancy from Abbvie, Janssen, Pfizer, Amgen, and Takeda. He has received research support from Ferring, Janssen, Abbvie, GlaxoSmith Kline, Merck, and Shire. He shares ownership of a patent: TREATMENT OF INFLAMMATORY DISORDERS, AUTOIMMUNE DISEASE, AND PBC. UTI Limited Partnership, assignee. Patent 62/ 555,397. A.R.O. has been on advisory boards of AbbVie Canada, Janssen Canada, and Nestle. He has received unrestricted educational grants from AbbVie Canada and Janssen Canada. His site is involved with clinical trials for AbbVie, Pfizer, Takeda, Eli Lily, and Celgene. A.M.G. has been a consultant for Abbvie, Amgen, BristolMyersSquibb, Janssen, Lilly, Pfizer, Roche; has received speaker fees from Abbvie, Janssen, Nestle, and investigator-initiated grant support from Abbvie. L.E.T. has received investigator initiated funding from Janssen Canada, and served on advisory boards for AbbVie Canada, Sandoz Canada, Takeda Canada, Merck Canada, Pfizer Canada, Janssen Canada, and Roche Canada. C.N.B. has been on the advisory boards of Abbvie Canada, Amgen Canada, Bristol Myers Squibb Canada, Janssen Canada, Pfizer Canada, Sandoz Canada, Takeda Canada, Roche Canada, and consulted to Takeda and Mylan Pharmaceuticals. He has been on the speaker{\textquoteright}s bureau for Abbvie Canada, Janssen Canada, Takeda Canada and Medtronic Canada. He has received unrestricted educational grants from Abbvie Canada, Janssen Canada, Pfizer Canada, and Takeda Canada and has done contract research with Abbvie, Janssen, Pfizer, Celgene, Boeringher Ingelheim, and Roche. K.J. has been on Advisory boards of Abbvie Canada, Janssen Canada, Merck Canada, and Mylan Pharmaceuticals. He has been on the speaker{\textquoteright}s bureau of Abbvie Canada and Janssen Canada. He has received investigator-initiated research support from Abbvie Canada and Janssen Canada. W.E.M. has received honoraria for speaking or consultancy from Abbvie and MERCK. H.S. has consulted to Amgen Canada, Bristol-Myers Squibb Canada, Sandoz Canada, Roche Canada, Takeda Canada, and Guardant Health. The remaining authors report no conflicts of interest. Funding Information: Sources of Funding: E.K. was supported by a Post-Doctoral Fellowship Award from the Canadian Institutes of Health Research (CIHR), Canadian Association of Gastroenterology (CAG), and Crohn{\textquoteright}s and Colitis Canada and a Mitacs Elevate Post-Doctoral Fellowship. D.R.M. receives partial funding through a University of Ottawa Faculty of Medicine Distinguished Clinical Research Chair in Pediatric Inflammatory Bowel Disease Award. L.M.L. was supported by a Tier I Canada Research Chair. E.I.B. was supported by a New Investigator Award from the CIHR, CAG, and Crohn{\textquoteright}s and Colitis Canada. E.I.B. was also supported by the Career Enhancement Program of the Canadian Child Health Clinician Scientist Program. Data availability statement: The data set from this study is held securely in coded form at ICES. While legal data sharing agreements between ICES and data providers (e.g., healthcare organizations and government) prohibit ICES from making the data set publicly available, access may be granted to those who meet prespecified criteria for confidential access, available at www.ices.on.ca/DAS (email: das@ices.on.ca ). The full data set creation plan and underlying analytic code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are, therefore, either inaccessible or may require modification. This work was supported by a Grant-in-Aid of Research from Crohn{\textquoteright}s and Colitis Canada, a Foundation Grant from the Canadian Institutes of Health Research (grant number 201409FDN-333131-FDN-CECC-164898), and a Canadian Institutes of Health Research Project Scheme Grant (Reference number PJT-162393). This study was supported by the ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Parts of this material are based on data and information compiled and provided by MOH and CIHI. Parts of this material are based on data and information provided by Alberta Health Services, Manitoba Health, Health Data Nova Scotia, and R{\'e}gie de l{\textquoteright}assurance maladie du Qu{\'e}bec. The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. Publisher Copyright: {\textcopyright} 2022 Lippincott Williams and Wilkins. All rights reserved.",

year = "2022",

month = aug,

day = "1",

doi = "10.1097/MPG.0000000000003489",

language = "English",

volume = "75",

pages = "173--180",

journal = "Journal of Pediatric Gastroenterology and Nutrition",

issn = "0277-2116",

publisher = "Lippincott Williams and Wilkins",

number = "2",

}

TY - JOUR

T1 - Hospitalization with Clostridioides difficile in Pediatric Inflammatory Bowel Disease

T2 - A Population-Based Study

AU - Kuenzig, M. Ellen

AU - Benchimol, Eric I.

AU - Bernstein, Charles N.

AU - Bitton, Alain

AU - Carroll, Matthew W.

AU - Griffiths, Anne M.

AU - Kaplan, Gilaad G.

AU - Nguyen, Geoffrey C.

AU - Otley, Anthony R.

AU - Stukel, Therese A.

AU - Dummer, Trevor J.B.

AU - El-Matary, Wael

AU - Jacobson, Kevan

AU - Jones, Jennifer L.

AU - Lix, Lisa M.

AU - Mack, David R.

AU - Murthy, Sanjay K.

AU - Peña-Sánchez, Juan Nicolás

AU - Targownik, Laura E.

AU - Fung, Stephen G.

AU - Spruin, Sarah

AU - Coward, Stephanie

AU - Cui, Yunsong

AU - Filliter, Christopher

AU - Nugent, Zoann

AU - Siddiq, Shabnaz

AU - Singh, Harminder

N1 - Funding Information: E.I.B. has acted as a legal consultant for Hoffman La-Roche Limited and Peabody & Arnold LLP for matters unrelated to a medication used to treat inflammatory bowel disease or C. difficile infection. He has also acted as a consultant for McKesson Canada. G.G.K. has received honoraria for speaking or consultancy from Abbvie, Janssen, Pfizer, Amgen, and Takeda. He has received research support from Ferring, Janssen, Abbvie, GlaxoSmith Kline, Merck, and Shire. He shares ownership of a patent: TREATMENT OF INFLAMMATORY DISORDERS, AUTOIMMUNE DISEASE, AND PBC. UTI Limited Partnership, assignee. Patent 62/ 555,397. A.R.O. has been on advisory boards of AbbVie Canada, Janssen Canada, and Nestle. He has received unrestricted educational grants from AbbVie Canada and Janssen Canada. His site is involved with clinical trials for AbbVie, Pfizer, Takeda, Eli Lily, and Celgene. A.M.G. has been a consultant for Abbvie, Amgen, BristolMyersSquibb, Janssen, Lilly, Pfizer, Roche; has received speaker fees from Abbvie, Janssen, Nestle, and investigator-initiated grant support from Abbvie. L.E.T. has received investigator initiated funding from Janssen Canada, and served on advisory boards for AbbVie Canada, Sandoz Canada, Takeda Canada, Merck Canada, Pfizer Canada, Janssen Canada, and Roche Canada. C.N.B. has been on the advisory boards of Abbvie Canada, Amgen Canada, Bristol Myers Squibb Canada, Janssen Canada, Pfizer Canada, Sandoz Canada, Takeda Canada, Roche Canada, and consulted to Takeda and Mylan Pharmaceuticals. He has been on the speaker’s bureau for Abbvie Canada, Janssen Canada, Takeda Canada and Medtronic Canada. He has received unrestricted educational grants from Abbvie Canada, Janssen Canada, Pfizer Canada, and Takeda Canada and has done contract research with Abbvie, Janssen, Pfizer, Celgene, Boeringher Ingelheim, and Roche. K.J. has been on Advisory boards of Abbvie Canada, Janssen Canada, Merck Canada, and Mylan Pharmaceuticals. He has been on the speaker’s bureau of Abbvie Canada and Janssen Canada. He has received investigator-initiated research support from Abbvie Canada and Janssen Canada. W.E.M. has received honoraria for speaking or consultancy from Abbvie and MERCK. H.S. has consulted to Amgen Canada, Bristol-Myers Squibb Canada, Sandoz Canada, Roche Canada, Takeda Canada, and Guardant Health. The remaining authors report no conflicts of interest. Funding Information: Sources of Funding: E.K. was supported by a Post-Doctoral Fellowship Award from the Canadian Institutes of Health Research (CIHR), Canadian Association of Gastroenterology (CAG), and Crohn’s and Colitis Canada and a Mitacs Elevate Post-Doctoral Fellowship. D.R.M. receives partial funding through a University of Ottawa Faculty of Medicine Distinguished Clinical Research Chair in Pediatric Inflammatory Bowel Disease Award. L.M.L. was supported by a Tier I Canada Research Chair. E.I.B. was supported by a New Investigator Award from the CIHR, CAG, and Crohn’s and Colitis Canada. E.I.B. was also supported by the Career Enhancement Program of the Canadian Child Health Clinician Scientist Program. Data availability statement: The data set from this study is held securely in coded form at ICES. While legal data sharing agreements between ICES and data providers (e.g., healthcare organizations and government) prohibit ICES from making the data set publicly available, access may be granted to those who meet prespecified criteria for confidential access, available at www.ices.on.ca/DAS (email: das@ices.on.ca ). The full data set creation plan and underlying analytic code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are, therefore, either inaccessible or may require modification. This work was supported by a Grant-in-Aid of Research from Crohn’s and Colitis Canada, a Foundation Grant from the Canadian Institutes of Health Research (grant number 201409FDN-333131-FDN-CECC-164898), and a Canadian Institutes of Health Research Project Scheme Grant (Reference number PJT-162393). This study was supported by the ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Parts of this material are based on data and information compiled and provided by MOH and CIHI. Parts of this material are based on data and information provided by Alberta Health Services, Manitoba Health, Health Data Nova Scotia, and Régie de l’assurance maladie du Québec. The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.

PY - 2022/8/1

Y1 - 2022/8/1

N2 - Objectives: 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. Methods: 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. Results: 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). Conclusions: 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.

AB - Objectives: 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. Methods: 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. Results: 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). Conclusions: 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.

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UR - http://www.scopus.com/inward/citedby.url?scp=85135120755&partnerID=8YFLogxK

U2 - 10.1097/MPG.0000000000003489

DO - 10.1097/MPG.0000000000003489

M3 - Article

C2 - 35675701

AN - SCOPUS:85135120755

SN - 0277-2116

VL - 75

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EP - 180

JO - Journal of Pediatric Gastroenterology and Nutrition

JF - Journal of Pediatric Gastroenterology and Nutrition

IS - 2

ER -

Hospitalization with Clostridioides difficile in Pediatric Inflammatory Bowel Disease: A Population-Based Study

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