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P211 Positivity of stool sampling for enteric pathogens during inflammatory bowel disease flares in paediatric patients and its impact on disease outcomes

P. Melnik, M. Matar, R. Shamir, A. Assa

Institute of Gastroenterology, Nutrition and Liver Diseases, The Schneider Children’s Medical Center, Petach Tikva, Israel

Background

Enteric infections due to Clostridium difficile toxin (CDT) is more common in patients with inflammatory bowel disease (IBD). We aimed to assess the frequency and outcomes of CDT and non-CDT enteric infections in symptomatic paediatric patients with IBD.

Methods

Patients’ records were retrospectively searched for disease flares in which stool samples were collected. Each patient with a positive sample was matched with a patient with IBD flares and negative sample in order to analyse 1-year outcomes following sampling.

Results

A total of 618 paediatric patients with IBD (Crohn’s disease, n = 439, 71%, mean age at diagnosis 12.99 ± 3.4, females, n = 264, 42.7%) had 1204 stool samples during the study period (2001–2018). Of these, 43 (3.6%) were positive for bacteria, and 32 (74.4%) of which positive for Campylobacter jejuni. Of 463 samples for CDT, 31 (6.7%) were positive while parasitic infection was rare, 11/765 (1.4%). Overall, 19 positive C. jejuni cases and 19 positive CDT cases with matching controls were examined. During 12 months of follow-up, the mean number of disease flares and ER visits was higher among patients with positive CDT (1.5 ± 1.4 vs. 0.5 ± 0.9, p = 0.019, 1.3 ± 1.5 vs. 0.4 ± 0.8, p = 0.05, respectively) with a numeric increase of surgical interventions (3 vs. 0). There were no significant differences in disease outcomes between patients with C. jejuni infections and matched controls.

Conclusion

Clostridium difficile and Campylobacter jejuni are the most common enteric infections among paediatric patients with IBD but only clostridial infection results in a more severe disease course within 12 months of infection.