Controversies Surrounding Clostridium difficile Infection in Infants and Young Children.

Maribeth Nicholson,Isaac Thomsen,Kathryn Edwards

doi:10.3390/children1010040

Maribeth Nicholson, Isaac Thomsen + Show 1 more

Open Access

https://doi.org/10.3390/children1010040

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Journal: Children	Publication Date: Jun 13, 2014
Citations: 40	License type: CC BY 4.0

Affiliation: Vanderbilt University

Abstract

Clostridium difficile is a frequent cause of antibiotic-associated diarrhea in adults and older children. However, as many as 80% of infants can be asymptomatically colonized. The reasons for this have not been well established but are believed to be due to differences in toxin receptors or toxin internalization. Determining which children who test positive for C. difficile warrant treatment is exceedingly difficult, especially in the setting of increased rates of detection and the rising risk of disease in children lacking classic risk factors for C. difficile.

Highlights

Clostridium difficile is a frequent cause of antibiotic-associated diarrhea in adults and older children
C. difficile infections have been extensively studied in adults, where both the incidence and severity of CDI are increasing in the United States [2]
In two studies of inpatients age 2 years and younger, no significant difference was observed in C. difficile positivity between patients with diarrhea and asymptomatic controls [14,15]

Summary

Increasing Rates of Clostridium difficile Infection

Clostridium difficile, a spore forming Gram-positive bacillus, is the most frequent cause of antibiotic associated diarrhea in children and adults. C. difficile infections have been extensively studied in adults, where both the incidence and severity of CDI are increasing in the United States [2]. Zilberberg et al reported that the annual rate of pediatric hospitalization with CDI in the USA climbed from 7.24 to 12.8/10,000 hospitalizations during the period from 1997 to 2006 [3] Another multicenter study from 22 pediatric hospitals across the United States found that the annual incidence of C difficile-associated disease in hospitalized children nearly doubled over a five year period (from 26 to 40 per 10,000 admissions from 2001 to 2006) [4]. CDI is developing as a worldwide pathogen. The epidemiology of CDI in children is changing, with increased rates of infection in those patients without known risk factors such as antibiotic use or healthcare exposures [7]. (NAP1) may be at least partially responsible for these changes [8]

High Rates of Colonization in Infancy

Toxigenic Strains in Infants

Testing Recommendations

Burden of Testing and Treatment

Findings

Conclusions