C. difficile Infection in Children: What’s New?

Abstract

The purpose of this review is to present the epidemiology of Clostridium difficile infection in children and to present a number of clinical challenges in diagnosis and therapy that are unique to the pediatric population. Current research has focused on novel methods of prevention and treatment of C. difficile infection in children. Fecal microbial transplantation (FMT) for recurrent C. difficile is increasingly prescribed for children, and recent data includes comparisons of effectiveness and tolerability between methods of delivery. The incidence of C. difficile infection in children has risen in recent decades both in healthy children and those with underlying comorbidities. Antibiotic use, acid suppressive medication use, and the presence of enteric feeding tubes are well-documented risk factors. There is no standard method of testing for C. difficile infection in children, which complicates epidemiological tracking and detection of active disease versus asymptomatic colonization. First-line therapy for initial infection in children is metronidazole, while vancomycin may be reserved for those with severe infection or high risk of complications. Recurrence of infection is frequent, and while repeat courses of antibiotics may be effective, fecal microbial transplant should be considered a safe and efficacious alternative therapy.