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P693. Prevalence of Clostridium perfringens infection in pediatric patients with inflammatory bowel disease: a pilot study

A. Banaszkiewicz1, A. Gawronska1, J. Kadzielska2, I. Lazowska-Przeorek1, K. Karolewska-Bochenek1, P. Obuch-Woszczatynski2, D. Wultanska2, H. Pituch2, A. Radzikowski1, 1Medical University of Warsaw, Dept of Paediatric Gastroenterology and Nutrition, Warsaw, Poland, 2Medical University of Warsaw, Dept of Medical Microbiology, Warsaw, Poland

Background

Growing amount of scientific evidence suggests that superimposed infections of pathogenic bacteria may have deleterious effect on the clinical course of inflammatory bowel disease (IBD). The most important is Clostridium difficile infection – the major cause of antibiotic-associated diarrhea. Clostridium perfringens infection has also been detected in up to 15% of antibiotic-associated diarrhea cases; it has not been found in healthy people. IBD patients are not routinely tested for C. perfringens toxin. The aim of the study was to investigate the prevalence of Clostridium perfringens infection in pediatric patients with IBD.

Methods

It was a prospective study evaluating pediatric IBD patients in Department of Paediatric Gastroenterology and Nutrition, Warsaw, Poland. All patients were diagnosed according to Porto criteria. The severity of IBD was evaluated by determining the Pediatric Crohn's Disease Activity Index for Crohn patients and the Pediatric Ulcerative Colitis Activity Index for ulcerative colitis patients; a PCDAI and a PUCAI score <10 were defined as a remission. Stool samples were collected at the day of admission. Clostridium difficile and Clostridium perfringens infection diagnosis was based on a positive stool enzyme immunoassays (C. difficile TOX A/B II, TechLab, Blacksburg, VA and C. perfringens enterotoxin test kit TechLab, respectively).

Results

Between March 2011 and October 2012, 90 fecal specimens from patients with IBD were collected. The incidence of Clostridium perfringens infection was 9% (8/90), the incidence of Clostridium difficile infection was 23% (21/90). No specimens contained both C. difficile toxins and C. perfringens enterotoxin. Average age of patients was similar in both C. difficile and C. perfringens groups (12.7 vs. 11.7 years). There were more Crohn's patients (6/8) in C. perfringens group than in C. difficile group (9/21). There was no statistically significant difference in the median disease activity between the C. perfringens group and C. difficile group (15.2 points vs. 13.6 points, respectively).

Conclusion

The prevalence of Clostridium perfringens infection in pediatric IBD patients was 9%. Our pilot data add to the evidence base that Clostridia other than C. difficile may play a significant role in clinical IBD course, however further studies are needed to confirm this hypothesis.