Clostridioides difficile in Paediatric Inflammatory Bowel Disease: A Retrospective Cross-Sectional Analysis of the East London Region.

OBJECTIVE: Clostridioides difficile is a major cause of healthcare-associated diarrhoea, and patients with inflammatory bowel disease (IBD) are thought to be highly susceptible to both colonisation and C. difficile-associated disease (CDAD). AIM: to characterise rates of C. difficile test positivity among paediatric stool samples submitted for clinical testing at a single East London centre, comparing samples from patients with IBD to those from patients without IBD. METHODS: Retrospective analysis of stool testing episodes from patients aged ≥ 1 year between April 2020 and November 2022. Samples were tested using glutamate dehydrogenase (GDH) immunoassay, toxin A/B immunoassay, and toxigenic gene polymerase chain reaction (PCR). Fisher's exact testing compared positivity rates between samples from patients with IBD and those from patients without IBD. RESULTS: In total, 470 stool testing episodes from 334 unique patients were included; 155 samples were from patients with IBD and 315 were from patients without IBD. Overall, 15.9% (n = 75) of testing episodes were positive for GDH and 2.5% (n = 12) for toxin. GDH positivity was significantly lower in the IBD group (7.7%) compared with the non-IBD group (20%) (p = 0.0005). However, there was no statistically significant difference in toxin positivity between IBD (1.3%) and non-IBD (3.2%) groups (p = 0.35), or in the presence of the toxigenic gene (p = 0.16). CONCLUSIONS: In this single-centre, laboratory-based cohort of paediatric samples submitted for clinical testing, GDH positivity was lower in samples from patients with IBD than in those from patients without IBD, while toxin positivity did not differ significantly between groups. These findings should not be interpreted as population prevalence estimates, but they support continued vigilance for CDAD in paediatric patients with IBD undergoing clinical testing.