Management and outcome of bacterial gastrointestinal infections in children and adolescents with inflammatory bowel disease A retrospective study at the Department of Paediatrics and Adolescent Medicine (Medical University of Graz, 2011–2021)

Abstract

Background and Research Aim: Patients with paediatric inflammatory bowel diseases (PIBDs) are more susceptible to infections due to gastrointestinal dysbiosis, intestinal barrier dysfunction, and the need for (intensive) immunosuppressive therapy (IST), often necessitated by the disease’s extent and severity. IST particularly increases the risk of opportunistic infections. The aim of this study was to investigate the epidemiology of bacterial gastrointestinal (GI) infections in PIBD patients at the Department of Paediatrics and Adolescent Medicine of the Medical University of Graz, and evaluate outcome and management, particularly in terms of infection management with antibiotics and handling of immunosuppression during bacterial GI infections, aiming to contribute to the limited data and guidelines available on this topic. Material and Methods: PIBD patients aged 0–18, who were treated at the Department of Paediatrics and Adolescent Medicine between 2011 and 2021were screened retrospectively for bacterial GI infections. Those who met the inclusion criteria were thoroughly evaluated to gather all the relevant information to meet the study’s objectives. This included reviewing their past medical history related to inflammatory bowel disease (IBD), the clinical course of the infection, laboratory and microbiological findings. This information was obtained by searching the local hospital information system, MEDOCS. Results: Initial screening included 139 PIBD patients, who were observed over a mean time period of 49 months (SD±33). 14 patients who experienced a total of 17 episodes of bacterial GI infections were included in the study. Of those, three patients experienced two episodes each. This equals an incidence rate of three cases of bacterial GI infections per 100 person years. Almost every identified pathogen (Clostridioides difficile, Campylobacter jejuni, Klebsiella oxytoca, Arcobacter butzleri, Aeromonas hydrophila, Salmonella Enteritidis) was classified as opportunistic. Ten infections were managed with antibiotic therapy (ABT), and a total of 12 patients were receiving IST at the onset of the infection. (Combined) IST regimens were followed, with some patients receiving corticosteroids (3/12), immunomodulators (9/12), and/or biologics (3/12), either alone or in combination. Escalation of IST due to uncontrolled IBD was necessary in six cases of infection. Five infections led to hospitalisation, and one infection with Clostridioides difficile progressed to sepsis, and the patient required ICU care. Thus, the incidence of severe cases was 0.2 per 100 person years. Conclusion: Our study’s findings reveal that bacterial GI infections showed a low incidence and, in most cases, did not follow a severe course. The most common pathogen was Clostridioides difficile. Most patients were on IST at the onset of infection. IST was not withheld during an infection and was intensified in cases of increased IBD activity, while ABT was administered as needed.

Date of Award	2024
Original language	English
Awarding Institution	Medical University Graz
Supervisor	Benno Kohlmaier (Supervisor) & Almuthe Hauer (Co-supervisor)