Abstract
Background Clostridium difficile infection (CDI) is associated with significant morbidity and mortality in adults. There is increasing evidence of the pathogenic role of C. difficile in the paediatric population. We sought to ascertain the clinical presentation and severity of CDI in children at our institution and develop criteria to aid management.MethodsClinical data was retrospectively collected from all children (0–16 yrs) with a positive C. difficile toxin result over a 5-year period. National adult guidelines were used to assess the severity and management of CDI.ResultsSeventy-five patients were included with a mean age of 2.97 years. Forty-nine were hospital onset, 22 community onset and 4 healthcare-associated. The most common co-morbidity among the hospital onset infections was malignancy. Gastrointestinal conditions were most common among community onset infections. Fifty-five cases (73.3%) had received antibiotics in the preceding month, 7 (9.3%) had cow’s milk intolerance and 9 (12%) had co-infection with another gut pathogen. According to national adult guidelines 57 cases (76%) were categorised as severe. Thirty cases received oral metronidazole, two patients required intensive care and one patient had a sub-total colectomy for pseudomembranous colitis. No mortality was observed.DiscussionWe confirm the association of paediatric CDI with co-morbidities such as haematological and solid organ malignancies, recent antibiotic use and hospitalisation. We observed an association between cows milk protein intolerance and C. difficile. The use of adult criteria overestimated severity of disease in this cohort, as most cases experienced a mild course of illness with low morbidity and no mortality. This indicates that adult scoring criteria are not useful in guiding management and we propose specific criteria for children.
Highlights
Clostridium difficile (C. difficile) is the commonest cause of hospital acquired diarrhoea in adults and is associated with significant mortality and morbidity. [1] The role of C. difficile in children is less certain
Numerous surveys and studies looking at the significance of isolating C. difficile in children show increasing evidence for a potential pathogenic role in the paediatric population. [2,3,4] C. difficile is becoming increasingly recognised as a significant co-morbid factor in prominent paediatric inpatient populations such as oncology [5,6,7,8] and with patients with gastrointestinal disorders. [9,10] Community onset C. difficile infection (CDI) without previous direct or indirect contact with a hospital environment remains rare compared with hospital onset Clostridium difficile infection (CDI)
CDI was strongly linked to antibiotic associated diarrhoea in children but symptoms were more likely to be severe in the presence of comorbidities such as malignancy and immunosuppression [12]
Summary
Clostridium difficile (C. difficile) is the commonest cause of hospital acquired diarrhoea in adults and is associated with significant mortality and morbidity. [1] The role of C. difficile in children is less certain. Clostridium difficile (C. difficile) is the commonest cause of hospital acquired diarrhoea in adults and is associated with significant mortality and morbidity. The convention is to regard C. difficile in stools in children less than two years of age to represent colonisation (i.e. not a cause of diarrhoea), severe disease does occur. Numerous surveys and studies looking at the significance of isolating C. difficile in children show increasing evidence for a potential pathogenic role in the paediatric population. A recently published literature review looking at colonisation and disease in children with C. difficile showed that C. difficile is frequently isolated from children of all ages and colonisation appears to occur soon after birth and rises to high levels at one year. Clostridium difficile infection (CDI) is associated with significant morbidity and mortality in adults. We sought to ascertain the clinical presentation and severity of CDI in children at our institution and develop criteria to aid management
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