Current practices and unmet needs in the management of Clostridioides difficile infection in pediatric inflammatory bowel disease: A national survey

OBJECTIVES: Children with inflammatory bowel disease (IBD) are at increased risk for Clostridioides difficile infection (CDI), which is associated with worse clinical outcomes. We aimed to assess current diagnostic and therapeutic practices for CDI among Italian pediatric IBD centers. METHODS: A nationwide survey was conducted in 2025 using a structured 28-item questionnaire distributed to all pediatric IBD centers in Italy. Items addressed diagnostic strategies, treatment approaches, recurrence management, and immunosuppressive therapy handling in children with IBD and CDI. RESULTS: Twenty-seven centers responded (response rate, 90%). Diagnostic approaches varied: toxin enzyme immunoassays (EIA) were indicated by 21/27 centers (78%), glutamate dehydrogenase (GDH) testing by 19/27 (70%), and nucleic acid amplification tests (NAAT) by 13/27 (48%). Routine CDI testing at IBD diagnosis was indicated by 12/27 centers (44%), whereas 23/27 (85%) reported testing during IBD flares. For a first non-severe episode, vancomycin and metronidazole were equally identified as preferred first-line options (18/27; 66% each). Oral vancomycin was the preferred treatment for recurrent CDI (26/27; 96%). Third or subsequent recurrences prompted consideration of fidaxomicin (19/27; 70%), fecal microbiota transplantation (6/27; 22%), and bezlotoxumab (2/27; 7%). In fulminant CDI, 7/27 centers (26%) indicated adding fidaxomicin to standard therapy. In acute severe colitis with concomitant CDI at diagnosis, 18/27 centers (67%) described a cautious approach to biologic initiation. CONCLUSIONS: This nationwide survey highlights substantial unmet needs in CDI management in pediatric IBD, including variability in diagnostic strategies, lack of consensus on first-line therapy, and uncertainty regarding immunosuppressive management, supporting the need for evidence-based pediatric-specific guidelines.

Authors

Institutions

Publication Details

Journal
Journal of Pediatric Gastroenterology and Nutrition
Published
2026-09-17
DOI
https://doi.org/10.1002/jpn3.70575
Primary Topic
Clostridium difficile and Clostridium perfringens research
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
article

Current practices and unmet needs in the management of Clostridioides difficile infection in pediatric inflammatory bowel disease: A national survey

Naire Sansotta, Michele Di Toma, Matteo Bramuzzo, Rita Cozzali et al.
Journal of Pediatric Gastroenterology and Nutrition
Clostridium difficile and Clostridium perfringens research
article

Current practices and unmet needs in the management of Clostridioides difficile infection in pediatric inflammatory bowel disease: A national survey

Naire Sansotta, Michele Di Toma, Matteo Bramuzzo, Rita Cozzali, Francesco Graziano, Martina Mainetti, Mara Corpino, Marina Aloi, Silvia Iuliano, E. Difrancisca, Laura Gianolio, Lorenzo D’Antiga, Luca Scarallo, Giovanni Di Nardo, Maria Teresa Illiceto, Giulia D’Arcangelo, Anna Opramolla, Francesca Musto, Antonio Marseglia, Simona Gatti, Vanessa Nadia Dargenio, Paola Sgaramella, Luca Bosa, Massimo Martinelli, A. A. Romanchuk, Claudia Banzato, Giovanna Zuin, Flavio Labriola, Matteo Motta, Antonio Colucci, the IBD SIGENP Working Group
article en

Abstract

OBJECTIVES: Children with inflammatory bowel disease (IBD) are at increased risk for Clostridioides difficile infection (CDI), which is associated with worse clinical outcomes. We aimed to assess current diagnostic and therapeutic practices for CDI among Italian pediatric IBD centers. METHODS: A nationwide survey was conducted in 2025 using a structured 28-item questionnaire distributed to all pediatric IBD centers in Italy. Items addressed diagnostic strategies, treatment approaches, recurrence management, and immunosuppressive therapy handling in children with IBD and CDI. RESULTS: Twenty-seven centers responded (response rate, 90%). Diagnostic approaches varied: toxin enzyme immunoassays (EIA) were indicated by 21/27 centers (78%), glutamate dehydrogenase (GDH) testing by 19/27 (70%), and nucleic acid amplification tests (NAAT) by 13/27 (48%). Routine CDI testing at IBD diagnosis was indicated by 12/27 centers (44%), whereas 23/27 (85%) reported testing during IBD flares. For a first non-severe episode, vancomycin and metronidazole were equally identified as preferred first-line options (18/27; 66% each). Oral vancomycin was the preferred treatment for recurrent CDI (26/27; 96%). Third or subsequent recurrences prompted consideration of fidaxomicin (19/27; 70%), fecal microbiota transplantation (6/27; 22%), and bezlotoxumab (2/27; 7%). In fulminant CDI, 7/27 centers (26%) indicated adding fidaxomicin to standard therapy. In acute severe colitis with concomitant CDI at diagnosis, 18/27 centers (67%) described a cautious approach to biologic initiation. CONCLUSIONS: This nationwide survey highlights substantial unmet needs in CDI management in pediatric IBD, including variability in diagnostic strategies, lack of consensus on first-line therapy, and uncertainty regarding immunosuppressive management, supporting the need for evidence-based pediatric-specific guidelines.

Journal of Pediatric Gastroenterology and Nutrition
University of Foggia (IT), University of Verona (IT), University of Parma (IT), University of Padua (IT), Vita-Salute San Raffaele University (IT), Scuola Superiore Sant'Anna (IT), IRCCS Materno Infantile Burlo Garofolo (IT), Shupyk National Healthcare University of Ukraine (UA), Casa Sollievo della Sofferenza (IT), Policlinico Umberto I (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Ospedale "Santa Maria delle Croci" di Ravenna (IT), Ospedale Maggiore Carlo Alberto Pizzardi (IT), Ospedale Vincenzo Cervello (IT), Ospedale Papa Giovanni XXIII (IT), Ospedali Riuniti di Ancona (IT), Ospedale di Santo Spirito (IT), Azienda Ospedaliera San Gerardo (IT), Meyer Children's Hospital (IT), Federico II University Hospital (IT), Santobono Children's Hospital (IT), Ospedale Microcitemico (IT), University of Campania "Luigi Vanvitelli" (IT), Ospedale Regina Margherita (IT), Ospedale dei Bambini Vittore Buzzi (IT), Ospedale Pediatrico Giovanni XXIII (IT), Ospedale Sant'Anna (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), University of Florence (IT), University of Naples Federico II (IT), Sapienza University of Rome (IT), University of Palermo (IT)
Good health and well-being
Openalex Percentile: Top 11%
Clostridium difficile and Clostridium perfringens research
DOISourceOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.