Risk for C. Diff Among Pediatric Sickle Cell Disease Patients

Venkata Sunkesula, MD, MS

Pediatric patients with sickle cell disease may be at risk for hospital-acquired Clostridioides difficile (C diff) infection for a variety of reasons, according to a poster presented at the annual American College of Gastroenterology (ACG) 2020 conference.

Investigators from Case Western Reserve in Cleveland, Ohio conducted a retrospective study in order to determine the epidemiology of C diff infection among the pediatric sickle cell disease population. They employed the IBM Explorys system, which the study authors described as a HIPAA-enabled web platform that includes the electronic health records from more than 65 million patients. From that database, the investigators identified patients aged less than 18 years with sickle cell disease – including hemoglobin SS, hemoglobin SC, and sickle beta-thalassemia – and those without sickle cell disease to compare the prevalence of C diff infection in both groups.

Ultimately, the investigators identified almost 12 million pediatric patients, of which 0.25%, or almost 30,000, had a diagnosis of sickle cell disease. The prevalence of C diff infection was significantly higher in the group of sickle cell disease patients compared to those without sickle cell disease (136 vs. 44, respectively). Additionally, none of the sickle cell disease patients with C diff infections had inflammatory bowel disease, the investigators noted.

The investigators found the patients with sickle cell disease might be at higher risk of C diff infection due to multiple hospitalizations, antibiotic exposure, and transfusions.

Among patients with both sickle cell disease and C diff infection, there were 30 males and 10 females, according to the study authors. However, in the cohort of C diff infection patients without sickle cell disease, it was closer to a 50/50 split. While most of the patients in the C diff infection-only cohort were white (72%), there were 20 participants who were Black, 10 participants who were Caucasian, and 10 participants who were categorized as “Other” in the group with both C diff infection and sickle cell disease.

While a majority of the patients with both diseases were under the age of 10, in the cohort with C diff infection only, it was about 50/50 when looking at those aged under 10 years compared to those aged between 10 and 19 years, the study authors determined.

The patient characteristics, comorbidities, and the like were all taken into consideration as well, the study authors noted. There was no difference in antibiotic exposure, they said, as both cohorts had about 70% of participants who had been exposed to antibiotics in the groups. Half of the patients with both diseases had experienced red blood transfusions, the study authors said, compared to just 8% of those with C diff infection only.

The researchers estimated the prevalence of C diff infection at about 40 in 30,000 for the sickle cell disease group and about 5,000 in 11.8 million for the non-sickle cell disease group, they wrote.

“Pediatric sickle cell disease patients who are asymptomatic carriers may be at risk of hospital-acquiredC diff infection due increased hospitalizations and transfusion need,” the study authors concluded, adding, “Further prospective studies are needed to evaluate the risk of C diff infection in pediatric sickle cell disease population.”

The study “A Population-Based Study: Prevalence of Clostridioides difficile Colitis in Pediatric Population With Known Sickle Cell Disease,” was published online by ACG 2020.​