Abstract Background Children with inflammatory bowel disease (IBD) are at increased risk for Clostridioides difficile infection (CDI), which may worsen disease outcomes. This study aimed to explore diagnostic and therapeutic strategies adopted by Italian pediatric IBD centers in managing CDI. Methods A nationwide survey was conducted in May 2025 by distributing a 28-item questionnaire to all pediatric IBD centers in Italy. The survey investigated diagnostic approaches, therapeutic management, and clinical decision-making related to CDI in children with IBD. Results Responses were obtained from 27 centers (response rate: 96%). The most commonly used diagnostic assays were enzyme immunoassays (EIA) for toxins and/or glutamate dehydrogenase (GDH) in 14/27 centers (52%), followed by nucleic acid amplification tests (NAAT) in 13/27 (48%). Only 12/27 centers (44%) routinely tested for CDI at IBD diagnosis, whereas 23/27 (85%) tested during disease flares, citing the challenge of distinguishing a flare from CDI. For a first, non-severe CDI episode, treatment preferences were split between vancomycin (66%) and metronidazole (66%). In contrast, nearly all centers (26/27; 96%) used oral vancomycin for recurrent CDI. For fulminant cases, 7/27 centers (26%) reported adding fidaxomicin to standard antibiotic therapy. In children presenting with severe acute colitis and concomitant CDI, 18/27 centers (67%) recommended a cautious approach when initiating biologic therapy, guided by multiple clinical factors. Conversely, in cases of CDI occurring during an IBD flare, 17/27 centers (63%) reported confidence in continuing ongoing immunosuppressive therapy. Conclusion This nationwide survey highlights considerable heterogeneity in diagnostic and therapeutic practices for CDI among pediatric IBD centers in Italy, particularly regarding testing strategies and first-line therapy. These findings emphasize the need for evidence-based, standardized guidelines to optimize management and improve outcomes in this high-risk population. Conflict of interest: Dr. Romanchuk, Anastasiia: No conflict of interest Bramuzzo, Matteo: No conflict of interest Labriola, Flavio: No conflict of interest Aloi, Marina: No conflict of interest Banzato, Claudia: No conflict of interest Bosa, Luca: No conflict of interest Colucci, Antonio: No conflict of interest Corpino, Mara: No conflict of interest Сozzali, Rita: No conflict of interest D’Arcangelo, Giulia: No conflict of interest Dargenio, Vanessa Nadia: No conflict of interest Difrancisca, Elvira: No conflict of interest Di Nardo, Giovanni: No conflict of interest Di Toma, Michele: No conflict of interest Gatti, Simona: No conflict of interest Gianolio, Laura: No conflict of interest Graziano, Francesco: No conflict of interest Illiceto, Maria Teresa: No conflict of interest Iuliano, Silvia: No conflict of interest Mainetti, Martina: No conflict of interest Marseglia, Antonio: No conflict of interest Martinelli, Massimo: No conflict of interest Motta, Matteo: No conflict of interest Musto, Francesca: No conflict of interest Opramolla, Anna: No conflict of interest Scarallo, Luca: No conflict of interest Sgaramella, Paola: No conflict of interest Zuin, Giovanna: No conflict of interest D’Antiga, Lorenzo: No conflict of interest Sansotta, Naire: No conflict of interest
Romanchuk et al. (Thu,) studied this question.