{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T13:58:27Z","timestamp":1780581507370,"version":"3.54.1"},"reference-count":79,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>\n                    <jats:italic>Clostridioides difficile<\/jats:italic>\n                    infection (CDI) represents a significant and increasingly recognized complication in children with inflammatory bowel disease (IBD), contributing to prolonged hospitalization and risk of adverse outcomes. Children with IBD are particularly susceptible due to frequent antibiotic exposure, healthcare system contact, immunosuppressive therapy, and underlying gut dysbiosis, all of which promote colonization and toxin-mediated intestinal injury. Distinguishing CDI from an IBD flare is challenging, as gastrointestinal symptoms and systemic inflammation overlap, and asymptomatic toxigenic colonization is common. Management recommendations for pediatric IBD-associated CDI are largely extrapolated from adult studies, with prompt initiation of targeted antibiotics being critical. Immunosuppressive therapy is generally continued, with escalation considered if diarrhea persists despite CDI-directed therapy. Fecal microbiota transplantation (FMT) has emerged as a safe and promising option for recurrent CDI in children with IBD, although careful patient selection, donor choice, and timing remain crucial. Key challenges persist in differentiating true CDI from IBD flares, understanding the clinical impact of asymptomatic colonization, and optimizing microbiome-targeted interventions. Future research should prioritize biomarker-driven diagnosis, individualized therapeutic strategies, and longitudinal evaluation of microbiome-based treatments to improve outcomes in pediatric patients with concurrent CDI and IBD.\n                  <\/jats:p>","DOI":"10.3389\/fped.2025.1753289","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T07:02:43Z","timestamp":1768892563000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clostridioides difficile infection in pediatric inflammatory bowel disease: current understanding and clinical challenges"],"prefix":"10.3389","volume":"13","author":[{"given":"Maria","family":"Rogalidou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"B1","volume-title":"Stat Pearls","author":"Mada","year":"2025"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.1056\/NEJMoa1306801","article-title":"Multistate point-prevalence survey of health care-associated infections","volume":"370","author":"Magill","year":"2014","journal-title":"N Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e2023062307","DOI":"10.1542\/peds.2023-062307","article-title":"Clostridioides difficile infection in children: recent updates on epidemiology, diagnosis, therapy","volume":"152","author":"Shirley","year":"2023","journal-title":"Pediatrics"},{"key":"B4","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.idc.2014.11.010","article-title":"Potential sources of Clostridium difficile in human infection","volume":"29","author":"Bauer","year":"2015","journal-title":"Infect Dis Clin North Am"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1076","DOI":"10.1017\/ice.2020.1367","article-title":"Timing and route of contamination of hospitalized patient rooms with healthcare-associated pathogens","volume":"42","author":"Redmond","year":"2021","journal-title":"Infect Control Hosp Epidemiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1016\/j.jhin.2009.02.019","article-title":"Contamination of pet therapy dogs with MRSA and Clostridium difficile","volume":"72","author":"Lefebvre","year":"2009","journal-title":"J Hosp Infect"},{"key":"B7","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1038\/s41579-021-00660-2","article-title":"Clostridioides difficile toxins: mechanisms of action and antitoxin therapeutics","volume":"20","author":"Kordus","year":"2022","journal-title":"Nat Rev Microbiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1093\/femsre\/fux048","article-title":"The role of toxins in Clostridium difficile infection","volume":"41","author":"Chandrasekaran","year":"2017","journal-title":"FEMS Microbiol Rev"},{"key":"B9","doi-asserted-by":"publisher","first-page":"813","DOI":"10.22038\/ijbms.2019.35223.8390","article-title":"Toxin profiles and antimicrobial resistance patterns among toxigenic clinical isolates of Clostridioides (Clostridium) difficile","volume":"22","author":"Heidari","year":"2019","journal-title":"Iran J Basic Med Sci"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.anaerobe.2013.05.005","article-title":"A clinical and epidemiological review of non-toxigenic Clostridium difficile","volume":"22","author":"Natarajan","year":"2013","journal-title":"Anaerobe"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e0018023","DOI":"10.1128\/jb.00180-23","article-title":"The microbial-derived bile acid lithocholate and its epimers inhibit Clostridioides difficile growth and pathogenicity while sparing members of the gut microbiota","volume":"205","author":"Kisthardt","year":"2023","journal-title":"J Bacteriol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.3390\/jpm13091413","article-title":"Multifaced aspect of Clostridium difficile infection in pediatric patients with inflammatory bowel disease. 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